Atrial fibrillation

The ECG label is the easy part. The decision is whether the patient is unstable, and what the rhythm means for stroke risk later.

• No consistent P waves and an irregularly irregular rhythm is atrial fibrillation.
• Shock, ischemia, or severe heart failure with a fast rate is a different priority from a comfortable patient.
• A stroke-risk decision is not the same act as immediate cardioversion.

The atria fibrillate. The AV node conducts irregularly. Loss of atrial contribution and a very fast rate can drop output. Stasis in the appendage is why stroke risk is a separate question.

Name the rhythm, then ask if this person is unstable right now.

• A 12-lead ECG, not a pulse check alone.
• Look for a trigger: ischemia, infection, pulmonary embolism, thyroid disease, alcohol, blood loss.

Immediate

If the patient is unstable because of the rhythm, urgent electrical cardioversion is the emergency concept. If they are stable, do not copy that plan.

Definitive

Rate or rhythm strategy, treatment of the trigger, and a stroke-risk decision using a current validated approach. Point scores change between guidelines. This page does not print a point total or a drug dose.

Monitoring

Rate, blood pressure, and heart failure symptoms after any acute change. Anticoagulation is a bleeding decision as well as a stroke decision.

• Cardioverting a stable patient because the ECG looks untidy.
• Withholding a stroke-risk conversation because the rate is now controlled.
• Using a memorized point score from an old edition.

Items ask you to label the ECG, then choose a different next step for the shocked patient and the comfortable one.

Opens original Mahazanaka questions in this subject. If this subject is thin on that track, the session uses what exists.

1. Recognize. Irregularly irregular, no P waves.
2. Reason. Is output failing because of this rhythm, or is the person stable?
3. Prioritize. Perfusion first. Stroke risk is real and is not the same minute.
4. Act safely. Emergency cardioversion only for instability. Otherwise a controlled plan.

• ECG: rate 140, no P waves, irregularly irregular, blood pressure normal, comfortable. What is the rhythm, and is immediate cardioversion required?

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