Abrupt A-fib causes?

[whitecat5000]

Alright. Need some critical thinking here from others because I've exhausted mine and ended up with nadda. I'm also a new grad (3 months) so I'm still new at this stuff.

Had a patient admitted with abdominal pain and diagnosed with a pancreatic pseudo-cyst. Then patient starts getting SOB and dr orders SVN treatments prn. Her lungs cleared up within a day.

Tonight my patient took off her O2 to go to the bathroom (like she's been doing for the past two days), gets back in bed, and goes into A-fib and I get to transfer her to PCU for a Cardizem drip.

I can't figure out what caused it. She has some things that could have caused it, but none are new. HTN, CHF, obesity, and diabetes.

The only thing I can think of is that during AM shift there was a critical K of 2.7 but it was corrected by 1400. The A-fib started at 0430.

Can it take that long for the heart to react? Am I missing something?

[SkylerW]

The cause of A-fib is most of the time unknown.

[Biffbradford]

Sometimes they say the heart is just 'irritable'. Dehydration can cause afib in some people, perhaps from the lytes being off or the poor pre-load. Some people live with it chronically.

[nursej22, MSN, RN]

Yep, if you can find the cause of afib and prevent it, you'll be rich beyond your wildest dreams.

Your patient may have been going in and out of afib pre-hospital, but you just happened to catch it and document it.

Atrial stretching (from CHF), increased levels of catecholamines from stress can set it off. We get lots of LOLs transferred to our floor because they go into afib perioperatively. Give them some metoprolol, maybe a whiff of dilt and/or dig, and they convert within a day or 2.

The pharmaceutical industry puts lots of energy into new antiarrhythmics( Tikosyn, Multaq), but nothing works for everyone everytime.

The main thing that seems to work on our post open heart surgery patients is get them discharged before they go into afib.

[ChristineN, BSN, RN]

I have had young 20 something man come into the ER, that presented in new onset afib. Neg tox screen. Sometimes you just don't know what causes it.

[nurseprnRN, BSN, RN]

i know you said pancreatic pseudocyst, and this has nothing to do c it (disclaimer).

one common cause of afib is the classic "holiday heart," where a guy (it's usually a guy) comes into the er in afib on sunday afternoon having indulged mightily on alcohol on friday and saturday. usually self-limiting. pancreatitis is often (but not always) a result of alcohol, too.

[MCRNENC(C)]

The patient has pancreatic pseudo-cyst and a critical K of 2.7 Those two stressors alone could have cause the onset of A Fib - add to that her pre-existing conditions of HTN, CHF, obesity, and diabetes; it could have been a "perfect storm" type of scenario. And - as with many medical conditions - sometimes a definite cause cannot be identified.

[Been there,done that, ASN, RN]

That would be.... sleep apnea!

[MaleBSNRN]

Lack of oxygen and physical exertion contributing factors?

[nurseprnRN, BSN, RN]

"that would be.... sleep apnea!:"

oooh, gold star! (and a kudos too!) (yes, the word "kudos" is singular, you can look it up)

[RNKPCE]

My pet peeve, pt wears oxygen while in bed not exerting self and then gets up to "just" go to the bathroom(exerts self more than in bed) and doesn't use oxygen. Not saying that is the cause because like most have already said the reason is usually unknown.