Atrial fibrillation - page 2

What are people with Atrial fibrillation at risk for? Acute MI or Pulmonary Embolus?... Read More

  1. Visit  GrnTea profile page
    2
    Quote from classicdame
    if the atrium continues to fibrillate the whole "electrical" system of the heart could get short-circuited and then the ventricles might be involved. In other words, it can lead to a lethal rhythm that results in MI.

    Pulmonary has to do the lungs. Of course the heart and lungs work together, but a patient with A-Fib has a cardiac issue, not a lung issue.
    Not quite sure what you mean by that. Many people have afib for years and years without even knowing it; people who have it diagnosed are not at any particularly higher risk because of the afib. Maybe because of what caused the afib in the first place-- an MI, cardiomyopathy, drug toxicity, who knows?-- but afib doesn't cause MI or ventricular arrhythmia all by itself.

    OP, what is afib? What happens to the heart when the atria aren't contracting in a coordinated fashion? What is the normal blood flow path through the heart and lungs? I regret that I can't do this in color showing blue for the venous side and red for the arterial, so you'll have to figure that out yourself (that's why you took anatomy). If a clot develops in the left atrium, where could it go? In the right atrium? There's your answer.

    veins > vena cava > right atrium > pulmonary artery > LUNGS > left atrium > left ventricle > aorta > body > capillary bed > veins ....

    (oh yeah: Atrium and auricle are the SAME THING. Auricle is just the old-fashioned term.)
    KelRN215 and Sun0408 like this.
  2. Visit  Newgraduatenurse2012 profile page
    0
    Most LIKELY a PE
  3. Visit  Morganalefey profile page
    0
    The big issue with Afib is the risk for clots.
  4. Visit  GrnTea profile page
    0
    Quote from Newgraduatenurse2012
    Most LIKELY a PE
    Actually, no, because clot is more likely to form in the LEFT atrium than the left, so the clot is more likely to exit out the left side of the heart to...?
  5. Visit  BostonFNP profile page
    0
    Quote from GrnTea

    Actually, no, because clot is more likely to form in the LEFT atrium than the left, so the clot is more likely to exit out the left side of the heart to...?
    I agree with the previous poster that a PE is more likely then an MI in uncontrolled AF due to the diastolic flow to the coronary circulation. I have sent out a number of patients with PEs 2/2 chronic PAF and I don't recall a situation where it was clear that AF preceded an acute MI.
    Last edit by BostonFNP on Dec 21, '12
  6. Visit  GrnTea profile page
    0
    Again, AF does not cause the MI. An MI could cause AF, though.
  7. Visit  BostonFNP profile page
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    Quote from GrnTea
    Again, AF does not cause the MI. An MI could cause AF, though.
    Exactly, for the OP the best answer would be PE.
  8. Visit  Stoogesfan profile page
    0
    Doesn't afib lead to strokes more than a PE? PE would result from DVT or right side of heart? Correct? Left side would lead to brain?
  9. Visit  BostonFNP profile page
    0
    Quote from Stoogesfan
    Doesn't afib lead to strokes more than a PE? PE would result from DVT or right side of heart? Correct? Left side would lead to brain?
    Definitely!
  10. Visit  GrnTea profile page
    1
    It's a lousy question, but it wants to know if you know your anatomy and cardiac conduction. PE is a better answer than MI, although both are theoretically possible because the coronary arteries originate....where???

    For extra credit, explain to your classmates here why DVT does not lead to stroke in a person with an otherwise normal heart (the vast majority of persons). You will be astonished at how many nurses believe that's the most compelling reason for worrying about DVT. It isn't.
    psu_213 likes this.
  11. Visit  psu_213 profile page
    0
    Quote from GrnTea
    You will be astonished at how many nurses believe that's the most compelling reason for worrying about DVT. It isn't.
    We even had an instructor try to explained how the DVT would lead to stroke....I felt pretty bad for her as she was trying to talk her way through it.
  12. Visit  GrnTea profile page
    0
    The only way in which this would be possible would be a cardiac malformation that allowed venous blood to go directly into the arterial circulation. These do exist (think single ventricle, Tetralogy of Fallot, and others), and are sometimes occult, but even in the case of an unsuspected ASD or VSD, you would also have to have higher pressure in the venous side than the arterial side to carry a clot over there. It does happen, but uncommonly. Regular old stuff, not so much. The pulmonary capillary bed is designed to be a strainer for all sorts of little clots that you develop normally; they dissolve harmlessly if they aren't too big, having been prevented by the size of the capillaries from getting over to the arterial side. Good engineering.
  13. Visit  MunoRN profile page
    0
    Embolic strokes that originate in the venous circulation or in the right heart are not all that exceedingly rare. The most common right to left shunt; a PFO, occurs in 25% of the population, hardly all that rare. Of patients with a stroke of unknown cause, PFO's are far more prevalent, occurring in 40% of those patients, suggesting that PFO's are responsible for a significant (as opposed to very rare) number of strokes. The L>R pressure gradient that occurs in systole does help prevent R to L flow during systole, however in diastole the pressure differences are essentially the same which allows intermittent pressure increases in the R heart (such as due to a cough or deep breath) to cause R to L flow.


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