Atrial Fibrillation (Afib)

Michael Emory

MTCC PNE

                                                 Atrial Fibrillation (Afib)  

Atrial Fibrillation (Afib)   is an irregular and often rapid heart rhythm.  The irregular rhythm, or arrhythmia, results from abnormal electrical impulses in the upper chambers (atria/atrium) of the heart that causes the heartbeat (ventricle contraction) to be irregular and usually fast.  The irregularity can be continuous, or it can come and go.  Some individuals, especially patients on medication, may have atrial fibrillation constantly but not have rapid (> 100 heartbeats per minute) at rest.  Normal heart contractions begin as an electrical impulse in the right atrium.  The impulse comes from an area of the atrium called sinoatrial (SA) or sinus node, the “natural pacemaker” that causes the normal range of regular heartbeats.  In an adult person with a normal heart rate and rhythm the heart beats 50-100 times per minute at rest.  If more than 100 time per minute, the heart rate is considered fast (tachycardia).  If the heart beats less than 50 times per minute, the heart is considered slow (bradycardia).

In atrial fibrillation, multiple sources of impulses other than only from the SA node travel through the atria at the same time.  Instead of coordinated contraction, the atrial contractions are irregular, disorganized, chaotic, and very rapid.  The atria may contract at a rate of 400-500 beats per minute.  The blood flow from the atria to the ventricles is often disrupted.  These irregular impulses reach the AV node in rapid succession, but not all of them make it past the AV node.  Therefore, the ventricles beat more slowly than the atria, often at fairly fast rated of 150-180 beats per minute in an irregular rhythm.  The resulting rapid, irregular heartbeat causes an irregular pulse and sometimes a sensation of fluttering in the chest.

Atrial fibrillation can occur in several different patterns:

Intermittent - The heart develops atrial fibrillation and typically converts back again spontaneously to normal (sinus) rhythm.  The episodes may last anywhere from seconds to days.

Persistent - Atrial Fibrillation occurs in episodes, but the arrhythmia does not convert back to sinus rhythm spontaneously.  Medical treatment or cardioversion (electrical treatment) is required to end an episode.

Permanent - The heart is always in atrial fibrillation.  Conversion back to sinus rhythm either is not possible or is deemed not appropriate for medical reasons.  In most cases, the rate is reduced by medications and the patients are placed on anticlotting medications for their lifetime.

Atrial Fibrillation or A Fib is one of the most common heart rhythm disorders.  It affects about 4% of the population, mostly people older than 60 years.  This amounts to more than 2.6 million people in the U.S.  People older than 40 have about a 25% chance of developing Afib in their lifetime.  The risk of developing A fib increases as we get older.  About 10% of people older than 80 years have atrial fibrillation.  For many people, A fib may cause symptoms but does no harm.

  Complications like blood clot formation, strokes and heart failure can arise, but appropriate treatment reduces the chances that such complications will develop.

 Some of the signs and symptoms that may be seen are shortness of breath, wheezing, chest tightness and edema in lower extremities.  Due to the possibility of edema and fluid retention of the patient the Dr. may perform a thoracentesis to remove fluid from the pleural space within the

chest wall. Latter a chest X ray may be ordered to check for fluid within the lower lobes of the lungs.  An EKG will show there is a rapid atrial flutter, along with Para pneumonia effusion.

Following these tests patients can be started on several different drugs:

1.  Digoxin (Lonoxin):   This drug decreases the conductivity of electrical impulses through the AV node.  Digoxin is currently used primarily in patients with associated heart disease, such as poorly functioning left ventricle.  The health care provider, nurses, and AP staff should monitor patient for edema and wheezing.

2.  Coumadin (Warfarin):  A blood anticoagulant that inhibits the function of Vitamin K dependent coagulation.  Coumadin is used to inhibit the coagulation of blood to reduce or prevent the chance of developing heart attacks, strokes and venous and other blood clots; deep vein thrombosis, pulmonary embolisms and thrombi produced by atrial fibrillation.  The most common side effect of this drug is bruising and bleeding.

3.  Lasix (Furosemide):  This drug belongs to a group of medications called loop diuretics (water pills).  Lasix is given to help treat fluid retention (edema) and swelling that is caused by congestive heart failure, liver disease and other medical conditions. Together with other medications it can be used to treat high blood pressure.  If this drug is used for a long time, the heart and arteries may not function properly.  This can damage many vital organs resulting in stroke, heart failure, or kidney failure.

Works Cited:

Brunner and Suddarth's Textbook of Medical Surgical Nursing, 12th Ed. Fundamentals of Nursing, 7th Ed. Clinical Nursing Skills Video Guide, 2nd Ed. Taylor's Clinical Nursing Skills, 3rd Ed. LWW DocuCare One Year Access North American Edition. N.p.: Lippincott Williams & Wilkins, 2013. Print.