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IMG Program
Carlos Yoo
Atrial Fibrillation
Multifocal atrial tachycardia
Supraventricular tachycardia
Pulmonary Embolism
Thyrotoxicosis
EKG
Thyroid Function tests
Cardiac enzymes
Echocardiogram
ABGA
Elderly patient
Palpitation
Fatigue/weakness
Long term hypertension
Tachycardia
Irregularly irregular rhythm
EKG: atrial fibrillation waves, inconsistent R-R
intervals, absence P waves.
ATRIAL FIBRILLATION
GOALS
Hemodynamic stabilization
Ventricular rate control
No
Unstable
Hypotension
Confusion
Cardioversion
Angina
.
Cont
Yes
No
Cardiversion
Start Heparin IV
Warfarin
Consider
long-term
anticoagulation
Yes
Aspirin
<48hs
Immediate
medical or
Long
standing HTN
electrical
Ischemic heart dz
cardioversion
CHF
Hyperthyroidism
Atrial fibrillation persist?
PE
Lung ca
No
Alcohol
Hypothermia
Assess cause of atrial
Electrolytes
fibrillation
imbalance
Etc. .
>48hs
Later elective
cardioversion
after 3weeks of
warfarin
Early TEEguided
cardioversion
http://www.chestjournal.org/content/13
5/3/849.full.html
http://www.aafp.org/afp/20020715/249.
html
http://www.aafp.org/afp/20020715/261.
html
http://www.americanheart.org/downloa
dable/heart/222_ja20017993p_1.pdf