Atrial fibrillation

  1. 0 What are people with Atrial fibrillation at risk for?

    Acute MI
    or
    Pulmonary Embolus?
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  3. Visit  Soliloquy profile page

    About Soliloquy, BSN, RN

    Soliloquy has '2' year(s) of experience and specializes in 'Med-Surg/Telemetry'. Joined Nov '11; Posts: 352; Likes: 204.

    34 Comments so far...

  4. Visit  classicdame profile page
    0
    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.
  5. Visit  psu_213 profile page
    3
    The issue with A fib is that blood stagnates in the heart, usually the left atrium and left auricle. This blood clots. The most common concern is that a clot moves from the atrium into the left ventricle and is "thrown" to the brain....stroke. To be honest, I don't know if such clots ever form on the right side of the heart and move to the lungs causing a PE (for a PE, we most often worry about clots from the deep veins of the legs...a DVT). If the clot forms in the left side of the heart, I'm not sure how often it gets pumped out of the heart and then moves into the coronary arteries, where it can cause an MI (heart attack).

    As I said, the most common clot related complication of A fib is a stroke. Both PEs and MIs can 'cause' A fib.
  6. Visit  turnforthenurseRN profile page
    0
    Quote from psu_213
    The issue with A fib is that blood stagnates in the heart, usually the left atrium and left auricle. This blood clots. The most common concern is that a clot moves from the atrium into the left ventricle and is "thrown" to the brain....stroke. To be honest, I don't know if such clots ever form on the right side of the heart and move to the lungs causing a PE (for a PE, we most often worry about clots from the deep veins of the legs...a DVT). If the clot forms in the left side of the heart, I'm not sure how often it gets pumped out of the heart and then moves into the coronary arteries, where it can cause an MI (heart attack).

    As I said, the most common clot related complication of A fib is a stroke. Both PEs and MIs can 'cause' A fib.
    Yup, with afib we worry about stroke. You need to make sure the patient is on anticoagulants and stress the importance of them.
  7. Visit  Sun0408 profile page
    1
    A. Fib has the greatest risk for a clot/stoke. The main tx if not converted is anti-coagulation to help prevent clots. Please read up on this, a simple google search will give you a lot of information. MI is rarely mentioned but heart failure is common but the number one risk is stroke.
    turnforthenurseRN likes this.
  8. Visit  Esme12 profile page
    1
    I think you would learn a lot more if you looked up a fib yourself.

    Atrial fibrillation - MayoClinic.com
    turnforthenurseRN likes this.
  9. Visit  Soliloquy profile page
    0
    Hey guys. Even though I learned (from a commercial on atrial fibrillation and yes, google) that someone with A.fib has a greatest risk for stroke, that wasn't a choice on the exam I took. I narrowed it down to two: Acute MI and pulmonary embolism.

    I chose Acute MI mainly because I figured that pulmonary embolisms are more of a lung issue and doesn't necessarily have to do with the heart. I also know that arrhythmias can occur after a heart attack, but the question asked, "What would a person with A. Fib be at greatest risk for?"


    Thanks for the link, Esme12. In doing a google search on Pulmonary embolisms though, I found an explanation on Wikipedia that talks about people developing PE as a result of obstruction of airflow to the lungs and pressure on the right ventricle. So my thinking is that Pulmonary embolism wouldn't be the right choice, mainly because A. fib would be an issue of the atriums of the heart.

    http://en.wikipedia.org/wiki/Pulmonary_embolism
  10. Visit  BostonFNP profile page
    3
    We certainly worry about PE with afib. Think about the pathophys: clots form in the atria an escape to a ventricle and are pushed out for systemic circulation. On the left they go to the brain (stroke) on the right they go where?

    And there is a big mistake in your description of PE, I would re-read that section on what a PE is.
    Last edit by BostonFNP on Dec 4, '12
    jessie25, KelRN215, and GrnTea like this.
  11. Visit  Esme12 profile page
    0
    I refer to wiki very little it isn't a good medical resource....besides not always being right.

    A Fib...and Atrial Fibrillation Medscape: Medscape Access medscape requires registration but it is free and an excellent resource.

    and What is Atrial Fibrillation?

    What is pulmonary embolism, pulmonary emboli
  12. Visit  Soliloquy profile page
    0
    Quote from de2013
    We certainly worry about PE with afib. Think about the pathophys: clots form in the atria an escape to a ventricle and are pushed out for systemic circulation. On the left they go to the brain (stroke) on the right they go where?

    And there is a big mistake in your description of PE, I would re-read that section on what a PE is.
    Okay. I'll check it out. Thanks for your response!
  13. Visit  Soliloquy profile page
    0
    Quote from Esme12
    I refer to wiki very little it isn't a good medical resource....besides not always being right.

    A Fib...and Atrial Fibrillation Medscape: Medscape Access medscape requires registration but it is free and an excellent resource.

    and What is Atrial Fibrillation?

    What is pulmonary embolism, pulmonary emboli
    Hey Esme! Wiki's so awesome though! lol But you're right, it isn't a very good medical resource, especially not for patients. I'll go check out your links on Pulmonary Embolism. I got that answer wrong on the test and someone told me the answer really was suppose to be PE but I couldn't "get" why.
  14. Visit  MunoRN profile page
    1
    Clot formation is more common in the left atrium, largely due to the left atrial appendage, but it does still occur in the right atrium as well. One large study that looked at thrombus occurrance in autopsies of A-fib patients found they occurred in the L atrium in 12% of patients and in the R atrium is 7% of patients, not dramatically different.

    L atrial emboli are more the focus of anticoagulation in A-fib patients in part due to the difference in severity of PE's vs Strokes, PE's can be deadly but are often treatable with minimal residual effects, while strokes often cause long term damage.

    Correlating PE's with A-fib can be difficult because PE's often cause A-fib, making it sort a chicken or the egg thing. PE's cause dilation of the RV and right atrium which stretches the conduction system, making the it more irritable.
    psu_213 likes this.
  15. Visit  Esme12 profile page
    0
    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


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