Can atrial fibrillation cause cardiogenic shock?

[Hacker]

I understand that atrial fibrillation (afib) can result from cardiogenic shock (CS), but I think in some cases, with rapid uncontrolled afib, cardiogenic shock can become a cause. What do you think? I'm having trouble finding white papers distinguishing afib as a cause, not an effect of CS. If the heart cannot pump properly, the blood would back up, decreasing cardiac output, which may lead to CS. Am I missing something?

 

 

 

 

[offlabel]

This is the type of standardized question that has bugged me since I became a nurse in 1988. The statement, 'atrial fibrillation does not  cause cardiogenic shock' is just false, but false with a qualification. If CS is defined by inadequate blood flow to vital organ systems, then if a rapid ventricular response associated with the a fib is present and any symptom at all relative to low blood flow (chest pain, syncope, lightheadedness) is also present, that by definition is cardiogenic shock. 

If ventricular filling is impeded as it can be with v tach or a fib with RVR and the patient is symptomatic, in both cases emergent cardioversion is called for. So if V tach can cause CS, certainly so can A fib (with RVR).

This is just a bad question and reflects the writer's lack of expertise in the area. There are going to be these types of poorly written questions in any standardized tests, that's why it's best to know your stuff so that when you get one of these, it won't mean the difference between success and failure. 

[Hacker]

Thank you very much for this detailed reply offlabel!

[sleepwalker, MSN, NP]

Don't read too much into the question...it asks about A-fib not A-fib with RVR. Keep the thought process as simple as possible and let the question guide you.

[Corey Narry, MSN, RN, NP]

sleepwalker said:

Don't read too much into the question...it asks about A-fib not A-fib with RVR. Keep the thought process as simple as possible and let the question guide you.

Agree, I participated in the AACN CMC and CSC practice question pool development and this is an example of a question where you have to look at the details. Yes, long-standing AFib with RVR can lead to cardiomyopathy and in essence, a risk for cardiogenic shock but not controlled Afib which many patients live with and do fine with.

[Phaleg]

To everyone with questions about getting shocked with a defibrillator. I am not positive but I do believe I am the current world record holder in how many times hit, in one episode of a heart attack. 19 times at my local hospital until Boston Med Flight showed up, they hit me 89 times with the defib on the way to Tufts in Boston, once there they hit me again for over 41 times. The total times hit with a defibrilator exceeds 149 times. I died for 52 minutes before being revived, as far as why they went so far above and beyond, not one doctor involved can explain it, they just kept saying it was a miracle, and they don't know why they couldn't stop. Now a few years later, and aside from the revive planted in my chest, and some hair loss from all the shocks, I seem to be fine. I wrote a book about it called The Reaper Sheds a Tear. And I am still alive and can be interviewed and examined should anyone have questions. I have my entire medical record to verify every single aspect of my story, it's no joke. 149 defib hits and dead for 52 minutes, still here trying to give someone any info they may want. [email protected] if you have questions.

[offlabel]

Thanks for the story...doesn't really apply to this conversation, but just a point of order, you weren't 'dead' as that is permanent. Full arrest for 52 minutes? That's very possible. 

[Phaleg]

Just going by how the doctors said " you died, FOR A LONG TIME" I'm just the patient, but still Tufts in Boston says I broke at least 5 records they know of.