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.