Afib and assessment

[rnstudent12]

I have a question, while in clinicals I did my assessment and listened to the heart. It sounded regular to me, s1s2 but the RN that I was working with told me the patient had a history of Afib and that a patient with afib would always have an irregular heartrate no matter what. The patient was not on tele and was in the hospital for abdominal pain and the MD was still ordering xrays, blood stools, and all.

For future reference, should I always hear an irregular heartrate with a patient who has a history of AFib or can it be a regular heartrate as I heard? Now I am doubting if I can hear heartrate regular and the pulses also felt regular for me too.

Thank you.

[turnforthenurse, MSN, NP]

You will be able to tell if the HR is irregular, either by palpating or auscultating. When I use a pulse ox (which also gives me the HR) if I see it jumping around a lot, I will always either listen apically (if I have a stethoscope, tho as a tech at my job I don't always have that on me) or take the pulse manually on the wrist and count for one full minute.

In my experience, pts with Afib have always had irregular rates. Also don't forget to ask about symptoms such as dizziness, syncope, fatigue, weakness and change in LOC (as well as other things) as these can be indicators of a decreased cardiac output, and in Afib you have lose that "atrial kick" which in turn loses 30% of your overall output! Also look at BP and peripheral pulses...a decrease in cardiac output often results in a decrease in BP.