Introduction[edit | edit source] Show
Atrial fibrillation is the most common type of heart arrhythmia. It is due to abnormal electrical activity within the atria of the heart causing them to fibrillate. Is characterized as a tachyarrhythmia ie the heart rate is often fast. Due to its rhythm irregularity, blood flow through the heart becomes turbulent and has a high chance of forming a thrombus which can dislodge and embolize to the brain and other parts of the body[1]. Watch this 1 minute video on AF Etiology[edit | edit source]The risk of developing AF is substantially higher in elderly individuals. Common causes of AF include long-term high blood pressure, coronary heart disease and valvular heart disease. Other risks for AF include obesity, having a thyroid condition, diabetes, chronic kidney disease, obstructive sleep apnoea, and smoking or consuming alcohol excessively. For some people, there is no apparent cause.[2] The 3 patterns of atrial fibrillation include:
Epidemiology/Prevalence[edit | edit source]The prevalence of atrial fibrillation has been increasing worldwide. It is known that the prevalence of atrial fibrillation generally increases with age. At the age of 80, the lifetime risk of developing atrial fibrillation jumps to 22%.[3] Pathophysiology[edit | edit source]There are a wide variety of pathophysiology mechanisms that play a role in the development of atrial fibrillation. Most commonly, hypertension, structural, valvular, and ischemic heart disease illicit the paroxysmal and persistent forms of atrial fibrillation but the underlying pathophysiology is not well understood. Some research has shown evidence of genetic causes of atrial fibrillation involving chromosome 10.[1] Clinical Presentation[edit | edit source]Often, people with AF do not know that they have it, and they do not experience any symptoms. Others may experience an irregular pulse, heart palpitations (‘fluttering’), fatigue, weakness, discomfort, shortness of breath or dizziness.[2] Associated Co-morbidities[edit | edit source]These include, but not limited to:; Stroke; Obesity; Obstructive sleep apnea; Diabetes; Congestive Heart Failure; Mitral valve disease; Coronary artery disease [4][5][6][7][8] Stroke can occur during atrial fibrillation. A blood clot forms in the left atrium of the heart, a piece of the clot breaks off and travels to an artery in the brain. See illustration. Diagnosis[edit | edit source]Atrial fibrillation is usually diagnosed using an electrocardiogram (ECG). Other tests include: 24-hour heart holter monitor; Cardiogram (heart ultrasound); Blood test; Stress tests; 6 minute walk test; Physical Exam: Irregular heart rate, irregular jugular venous pulsations, variation in the intensity of first heart sound.[4][9][5][6] Systemic Involvement[edit | edit source]High concentrations of CRP in the blood test, which confirm the presence of systemic inflammation are present in people with Atrial Fibrillation (AF).[4] Changes in an individual's health such as a newly diagnosed complication may have a psychological impact. Patients may experience depression and other psycho-social challenges as a result of changes in their health status, treatment, frequent visits to the physician's office, and fear of the unknown that may accompany a diagnosis of atrial fibrillation. Management[edit | edit source]Treatment strategy in recently diagnosed cases of atrial fibrillation includes identification and solution of reversible risk factors with anticoagulation therapy followed by beta-blockers.[10] Non-pharmacological therapy includes ablation therapy, a hospital procedure which inactivates small areas of tissue in the heart responsible for the abnormal electrical signals associated with AF. Pacemaker placement is considered in severe causes resulting in heart failure in atrial fibrillation[1]. People with prolonged or severe AF may undergo cardioversion. Pharmacological cardioversion uses medicines to achieve the same purpose. After cardioversion, long-term medicines are often prescribed to help prevent AF from reoccurring[2]. Physical Therapy Management[edit | edit source]There is limited research on the effect of traditional physical therapy and Atrial Fibrillation. Case Reports[edit | edit source]Ezekowitz MD, Aikens TH, Nagarakanti R, Shapiro T. Atrial fibrillation: outpatient presentation and management. Circulation. 2011; 124: 95–99. Available from: American Heart Association. Resources[edit | edit source]
References[edit | edit source]
What physical examination assessment can be done to assess for the presence of atrial fibrillation?Physical examination findings suggestive of atrial fibrillation include irregular pulse, irregular jugular venous pulsations, variations in the intensity of the first heart sound, or absence of a fourth heart sound heard previously during sinus rhythm. A diagnosis must be confirmed with electrocardiography (ECG).
What are normal physical assessment findings for a patient with AFIB?On physical examination, signs of AF include a faster-than-expected heart rate, which varies greatly from patient to patient, an “irregu- larly irregular” time between heart sounds on auscultation, and periph- eral pulses that vary irregularly in both rate and amplitude.
Which of the following assessment findings is associated with atrial fibrillation?Findings that may suggest atrial fibrillation or heart failure include: A rapid or irregular pulse and irregular heart sounds. Shortness of breath, especially during activity. Fatigue, weakness, and lightheadedness.
What are the classic signs in atrial fibrillation?During atrial fibrillation, the heart's upper chambers (the atria) beat chaotically and irregularly — out of sync with the lower chambers (the ventricles) of the heart. For many people, A-fib may have no symptoms. However, A-fib may cause a fast, pounding heartbeat (palpitations), shortness of breath or weakness.
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