Atrial fibrillation

Esme12, ASN, BSN, RN · Dec 12, 2012

Virchow’s triad in atrial fibrillation and the risk of stroke: Thrombus formation in patients with AF results from stagnant blood in the atria, combined with other physiological derangements.These abnormalities are consistent with the 3 factors first identified by Virchow as contributing to DVT formation. In AF, Virchow’s triad consists of:

Stagnant blood flow in the left atrium, visible on an echocardiogram as spontaneous echocontrast
Anatomical cardiac wall defects, such as progressive atrial dilatation
Abnormal platelet activation and changes in coagulation factors, contributing to an increased propensity for blood clot formation

Without anticoagulant therapy, patients with AF are at high risk of stroke, as a thrombus that forms in the atria can embolise to block blood flow to the brain.

Thrombosis and Atrial Fibrillation - Thrombosis Adviser

nurseprnRN, BSN, RN · Dec 12, 2012

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.)

Newgraduatenurse2012 · Dec 16, 2012

Most LIKELY a PE

Morganalefey · Dec 17, 2012

The big issue with Afib is the risk for clots.

nurseprnRN, BSN, RN · Dec 21, 2012

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...?

allnurses Guide · Dec 21, 2012

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.

nurseprnRN, BSN, RN · Dec 24, 2012

Again, AF does not cause the MI. An MI could cause AF, though.

allnurses Guide · Dec 25, 2012

Again AF does not cause the MI. An MI could cause AF, though.[/quote']
Exactly, for the OP the best answer would be PE.

Stoogesfan · Dec 25, 2012

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?

allnurses Guide · Dec 25, 2012

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!

nurseprnRN, BSN, RN · Dec 25, 2012

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, BSN, RN · Dec 26, 2012

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.