Atrial fibrillation acute

Cautions Recent major surgery (Coronary artery bypass graft, OB delivery, organ biopsy), cerebrovascular disease, recent GI or GU bleeding, hypertension, mitral stenosis with atrial fibrillation, acute pericarditis, bacterial endocarditis, hepatic/renal impairment, diabetic retinopathy, ophthalmic hemorrhaging, septic thrombophlebitis, occluded AV cannula at an infected site, advanced age, those receiving oral anticoagulants... 

Systemic anaphylaxis in man is frequently accompanied by electrocardiographic alterations ischemic ST waves, arrhythmias and atrial fibrillation [6-11]. Anaphylactic reactions after insect stings can lead to coronary spasm or acute myocardial infarction [12, 13]. Myocardial infarction can also occur as a consequence of idiopathic... 

The Heparin in Acute Embolic Stroke Trial (HAEST) was a multicenter, randomized trial of the effect of LMWH (dalteparin 100 lU/kg sc twice daily) or aspirin (160 mg once daily) for the acute treatment of 449 patients with ischemic stroke and atrial fibrillation (AF). The primary outcome was the rate of recurrent stroke within 14 days. No difference in rates of early recurrence (8.5% dalteparin treated vs. 7.5% aspirin treated) or good 3-month functional outcome was found. The frequency of early slCH was 2.7% on dalteparin versus 1.8% on aspirin. 

Berge E, Abdelnoor M, Nakstad PH, Sandset PM, on behalf of the Haest Study Group. Low molecular-weight heparin versus aspirin in patients with acute ischemic stroke and atrial fibrillation a double blind randomised study. Lancet 2000 335 1205-1210. 

Hart RG, Palacio S, Pearce LA. Atrial fibrillation, stroke, and acute antithrombotic therapy. Analysis of randomized clinical trials. Stroke 2002 33 2722-2727. 

Jprgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS. Acute stroke with atrial fibrillation. Stroke 1996 27 1765-1769. 

Electrocardiogram (ECG) May be normal or could show numerous abnormalities including acute ST-T-wave changes from myocardial ischemia, atrial fibrillation, bradycardia, and LV hypertrophy. 

FIGURE 6-2. Algorithm for the treatment of acute (top portion) paroxysmal supraventricular tachycardia and chronic prevention of recurrences (bottom portion). Note For empiric bridge therapy prior to radiofrequency ablation procedures, calcium channel blockers (or other atrioventricular [AV] nodal blockers) should not be used if the patient has AV reentry with an accessory pathway. (AAD, antiarrhythmic drugs AF, atrial fibrillation AP, accessory pathway AVN, atrioventricular nodal AVNRT, atrioventricular nodal reentrant tachycardia AVRT, atrioventricular reentrant tachycardia DCC, direct-current cardioversion ECG, electrocardiographic monitoring EPS, electrophysiologic studies PRN, as needed VT, ventricular tachycardia.)... 

Homestam, B., Jerling, M., Karlsson, M.O., and Held, P. DAAf Trial Group, Intravenously administered digoxin in patients with acute atrial fibrillation a population pharmacokinetic/pharmacodynamic analysis based on the digitalis in acute atrial fibrillation trial, Eur.. Clin. Pharmacol., 58, 747-755, 2003. 

ACLS advanced cardiac life support ACS acute coronary syndrome, American Cancer S ety, American Ctrilege of Surgeons ADH antidiuretic hormone ADHD attention-deficit hyperactivity disorder ADR adverse drug reaction AE adverse events AF atrial fibrillation AHA American Heart Association Al aluminum... 

Contraindications Phenylephrine HCl injection should not be used with patients with severe hypertension, ventricular tachycardia or fibrillation, acute myocardial infarction (Ml), atrial flutter or fibrillation, cardiac arrhythmias, cardiac disease, cardiomyopathy, closed-angle glaucoma, coronary artery disease, patients who have a known hypersensitivity to phenylephrine, sulfites, or to any one of its components. 

Intravenous ibutilide is used for the acute conversion of atrial flutter and atrial fibrillation to normal sinus rhythm. The drug is more effective in atrial flutter than atrial fibrillation, with a mean time to termination of 20 minutes. The most important adverse effect is excessive QT interval prolongation and torsade de pointes. Patients require continuous ECG monitoring for 4 hours after ibutilide infusion or until QTC returns to baseline. 

During the acute phase of thyrotoxicosis, B-adrenoceptor blocking agents without intrinsic sympathomimetic activity are extremely helpful. Propranolol, 20-40 mg orally every 6 hours, will control tachycardia, hypertension, and atrial fibrillation. Propranolol is gradually withdrawn as serum thyroxine levels return to normal. Diltiazem, 90-120 mg three or four times daily, can be used to control tachycardia in patients in whom blockers are contraindicated, eg, those with asthma. Other calcium channel blockers may not be as effective as diltiazem. Adequate nutrition and vitamin supplements are essential. Barbiturates accelerate T4 breakdown (by hepatic enzyme induction) and may be helpful both as sedatives and to lower T4... 

Of 86 cirrhotic patients treated with terlipressin 10 developed a tachycardia, four developed atrial fibrillation, and one developed ventricular tachycardia. Four patients in the same study developed hypertension (11). In another study, tachycardia occurred in 23% of patients randomized to pitressin for acute variceal bleeding and 8% developed transient hypertension (12). 

Mansour, M., Mandapati, R., Berenfeld, O., Chen, J., Samie, F. H., and Jalife, J. (2001). Left-to-Right Gradient of Atrial Frequencies During Acute Atrial Fibrillation in the Isolated Sheep Heart. Circulation 103(21) 2631—6. 

Khan IA, Nair CK, Singh N, et al. Acute ventricular rate control in atrial fibrillation and atrial flutter. IntJ Cardiol. 2004 97 7-13. 

Intravenous ibutilide is used for the acute conversion of atrial flutter and atrial fibrillation to normal... 

NPV = negative predictive value PPV = positive predictive value ACS = acute coronary syndrome PTCA = percutaneous transluminal coronary angioplasty PCI = percutaneous coronary intervention DCCV = direct-current cardioversion A fib = atrial fibrillation NA = not applicable. 

Cardiovascular Effects. No studies were located regarding cardiovascular effects of various forms of aluminum following intermediate- or chronic-duration oral exposure in humans. Acute-duration oral exposure to aluminum phosphide has been shown to cause tachycardia, hypotension, cardiovascular electrocardiographic abnormalities, subendocardial infarction, and transient atrial fibrillation in persons who either ingested it accidentally or in suicide attempts (Chopra et al. 1986 Khosla et al. 1988). However, toxicity was probably due to the formation of highly toxic phosphine gas rather than to aluminum exposure. 

Martinez-Marcos FJ, et al. Comparison of intravenous flecainide, propafenone, and amiodarone for conversion of acute atrial fibrillation to sinus rhythm. Am J Cardiol 2000 86(9) 950-953. 

Pedersen OD, Bagger H, Kober L, Torp-Pedersen C. Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction. Circulation 1999 100 376-380. 

For effectual rhythm control, the first action is often to restore NSR acutely with a nonsurgical intervention called a cardioversion, by which the patient s heart is reset through the use of electrical current strategically delivered to the heart via external electrode pads. When atrial fibrillation is changed to a normal sinus rhythm, the patient is said to have been converted. The cardioversion process has a good success rate for achieving conversion however, patients must be anesthetized for the procedure, and the AF often returns. 

In acute MI, the ISIS-1 study [88] was organized to assess the effects of early beta-blockade with atenolol on cardiovascular mortality during the first week following infarction and after long-term (mean 20 months) follow-up. There was a 15% reduction in vascular deaths, especially in the early phase of MI. The difference in early mortality was mainly due to a reduction in electromechanical dissociation in the presence of atenolol. In this regard, atenolol is usually given by intravenous injection or infusion to treat cardiac arrhythmias, and it should be noted that atenolol induced atrial fibrillation in half of the so-predisposed patients [89]. 

Mrs GG has atrial fibrillation which if not controlled can cause temporary loss of cardiac output resulting in a drop of blood pressure. Mrs GG s description of suddenly going dizzy associated with a jump in the chest suggest that her fall was probably caused by this. Her sudden dizziness is consistent with an arrhythmia and not some other acute cause such as epilepsy. 

Nattel S, Opie L (2006). Controversies in atrial fibrillation. Lancet 367 262-272 Ngeh J, Gupta S, Goodbourn C et al. (2003). Chlamydia pneumoniae in elderly patients with stroke (C-PEPS) a case-control study on the seroprevalence of Chlamydia pneumoniae in elderly patients with acute cerebrovascular disease. Cerebrovascular Diseases 15 11-16... 

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