Arrhythmias
Supraventricular arrhythmias
Premature atrial complexes (PACs)
General—generated from an atrial ectopic focus; therefore, P wave is different from sinus P wave
Clinical—typically asymptomatic
Risk factors—excess caffeine or alcohol, sympathomimetic drugs, structural heart disease
Treatment—none required; limit risks; β-blocker at low dose if uncomfortable symptoms
Atrial fibrillation (A-fib)
General—atria exhibit disorganized, rapid, irregular activity; the same for the ventricles
Clinical—EKG shows an irregularly irregular rhythm (see Figure 2.8.1)
May be asymptomatic at rates <A onclick="get_content(event,'AB1-M12'); return false;" onmouseover="window.status=this.title; return true;" onmouseout="window.status=''; return true;" title="<100
Likely symptomatic when rapid ventricular response (RVR)
Palpitations, lightheadedness, shortness of breath, weakness
Etiology (PIRATES)—(Patient may convert to regular rhythm if these causes are treated)
Pulmonary disease
Ischemia
Rheumatic heart disease
Atrial myxoma
Thyroid, Theophylline
Ethanol
Stimulants, Sepsis, Surgery
Epidemiology—3% to 5% of patients older than 60 years; 9% of patients older than 75 years
Risk Factors—hypertension (HTN), left ventricular hypertrophy (LVH), cardiomyopathy, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM) in ♀
Rhythm/rate management
Restoration of sinus rhythm in acute onset OR severe compromise from A-fib
If within 48 hours of new onset A-fib—chemical or electric cardioversion
If” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b66502057069cf249e39401dba8063d18}/ID(AB1-M10)”>>48 hours or unknown time, then ↑ chance of atrial thrombi. Get transesophageal echocardiograph
If thrombi, anticoagulate (international normalized ratio [INR] 2-3 for 3 weeks) precardioversion
If no thrombi, may cardiovert and utilize short-term anticoagulation
Rate control in chronic A-fib OR new-onset A-fib with RVR
then, 10 mg per hour in drip if needed
β-Blocker—Metoprolol 2.5 to 5 mg IV over 2 minutes; may repeat q5min up to a total dose of 15 mg as neededRelated posts:
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