New Onset AFIB..Is it an emergency?

Specialties Cardiac

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Hello! I am a visiting nurse, dealing mainly with the elderly and thought you cardiac nurses might give me some insight into a fairly common scenario. On occasion, I will encounter a patient in afib who last week was nsr. If pt is asymptomatic otherwise, how much of an emergency is this? Should 911 be called right away? Or can family take pt to hospital at their leisure? Appreciate your insights on this...thank you!

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Specializes in Oncology.

I've seen new onset afib managed outpatient many times if asymptomatic.

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Specializes in cardiac.

Agree with blondy..........depends on symptoms. SOB, chest pain, syncope means get to the ER now.

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Thanks! I'll remember that part about the syncope!

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Specializes in RETIRED Cath Lab/Cardiology/Radiology.

Some ppl flipflop back and forth from NSR to AFib.

If new onset may need cardiac w/u (see cardiologist, get echo, etc).

If pt is stable, is not an emergency but will need to be followed by Cardiology.

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Specializes in Cath Lab/ ICU.

Any rhythm can constitute an emergency. What matters is the pts response. Treat the pt not the monitor is a mantra you will hear over and over.

Let's rephrase your question to illustrate my point:

New onset sinus rhythm-is it an emergency?

I had a pt who was tachycardic for weeks during his ICU stay. He was gravely ill and 1:1 nursing care, many pressors, crrt, etc. During a procedure his HR dropped from the normal (for him) 130s to 75 and NSR. Is this an emergency?

Well, yes. He coded about 20 seconds after that.

So, know your rhythms. That's good. But know your patient. That's better. How they tolerate any rhythm is what will guide you in what to do next.

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Specializes in Oncology.
Any rhythm can constitute an emergency. What matters is the pts response. Treat the pt not the monitor is a mantra you will hear over and over.

Let's rephrase your question to illustrate my point:

New onset sinus rhythm-is it an emergency?

I had a pt who was tachycardic for weeks during his ICU stay. He was gravely ill and 1:1 nursing care, many pressors, crrt, etc. During a procedure his HR dropped from the normal (for him) 130s to 75 and NSR. Is this an emergency?

Well, yes. He coded about 20 seconds after that.

So, know your rhythms. That's good. But know your patient. That's better. How they tolerate any rhythm is what will guide you in what to do next.

Excellent post to illustrate the necessity of assessing your PATIENT, not lab results or an ekg strip. This is the value of good nursing care!

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Specializes in Tele, CVIU.
Any rhythm can constitute an emergency. What matters is the pts response. Treat the pt not the monitor is a mantra you will hear over and over.

Let's rephrase your question to illustrate my point:

New onset sinus rhythm-is it an emergency?

I had a pt who was tachycardic for weeks during his ICU stay. He was gravely ill and 1:1 nursing care, many pressors, crrt, etc. During a procedure his HR dropped from the normal (for him) 130s to 75 and NSR. Is this an emergency?

Well, yes. He coded about 20 seconds after that.

So, know your rhythms. That's good. But know your patient. That's better. How they tolerate any rhythm is what will guide you in what to do next.

Well said!

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Specializes in adult ICU.

I think you got your answer re: emergency or not, but I wanted to add this --

If it is truly new onset Afib, it at least warrants an MD appointment and a workup. There are many people that go in and out of Afib at home and it's not a big deal hemodynamically to them, HOWEVER -- it is likely that they need to be anticoagulated to some degree.

So, perhaps not an emergency, but should not be ignored (even if HD stable.)

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Specializes in Cardiac.
I think you got your answer re: emergency or not, but I wanted to add this --

If it is truly new onset Afib, it at least warrants an MD appointment and a workup. There are many people that go in and out of Afib at home and it's not a big deal hemodynamically to them, HOWEVER -- it is likely that they need to be anticoagulated to some degree.

So, perhaps not an emergency, but should not be ignored (even if HD stable.)

Agreed. If it is new usually HR is high (rapid ventricular response) and this needs to be treated. Afib can also be slow. So assess pts reaction. Afib pts are at greater risk for clots and need to be anticoagulated.

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Specializes in Emergency.

Heres my 2 cents:

I work on a tele unit and we get lots of new onset A-Fib. They are usually admitted 2 ways; either they went to their PCP who found it on a routine exam and want it worked up (the patient may be asymptomatic, but they may need coumadin and a sotalol load, which can require close monitoring for side effects and INR level), or the patient comes to the ER with C/O sob, weakness, and mabye syncope and/or palpitations. These pts are usually in what is called uncontrolled a-fib (hr >100) or in RVR (rapid ventricular response) which is a potential emergency and usually they are put on a cardizem drip and may need cardioversion if they don't get better. Some people never convert back and stay in a-fib, and some flip flop.

Either way the posters here are right. Your patients symptoms will tell you if it is an emergency.

Amy

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Specializes in Critical Care Nursing AKA ICU.

It's not an EMERGENCY unless pt is symptomatic... but can soon be an emergency if you leave the pt alone...

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