Question about A-fib with RVR

[salpaul]

My patient was admited to the ER with a CVA in his left temporal lobe due to chronic A-fib. When he was in the ER he had A-fib with RVR in the 130's-140's. My question is was the RVR a compensatory mechanism due to decreased oxygen to the brain? I don't understand why he had a RVR. Normally his A-fib is controlled.

[FireStarterRN, BSN, RN]

Maybe he had missed some meds, maybe it was the stress, could be any number of things.

[group_theory]

My patient was admited to the ER with a CVA in his left temporal lobe due to chronic A-fib. When he was in the ER he had A-fib with RVR in the 130's-140's. My question is was the RVR a compensatory mechanism due to decreased oxygen to the brain? I don't understand why he had a RVR. Normally his A-fib is controlled.

The RVR is due to the multiple foci from the atrium overdriving the heart, causing the ventricles to contract 130-140 times a minute. The problem with RVR is that it decreases diastolic filling time (meaning less time for blood to fill the ventricles before it is pumped).

In the setting of CVAs, the compensatory mechanism is actually hypertension to ensure perfusion. That's why in the setting of a stroke, you don't go crazy trying to normalize someone's BP.

The stroke is likely from his afib. He either wasn't properly anticoagulated, or he had contraindications for anticoagulation (GI bleed, fall risk, etc). Even if he was properly anticoagulated, it only reduces the risk of CVA (doesn't eliminate it completely). Same thing can be said of his afib - usually it is controlled with medications - either a betablocker, calcium channel blocker, digoxin, etc. . It can be through non-compliance, but sometimes the multiple atrial foci can still drive the ventricles into RVR despite medication.

Hope this helps.

[Daytonite, BSN, RN]

all rvr (rapid ventricular response) means is that some of the atrial electronic waves were getting through the junctional tissue of the heart and completing their electrical cycle so that a heartbeat in the ventricles could be affected. the only problem with a rapid heart beat in the 130-140 range is that it doesn't give enough time for a good amount of blood to fill the ventricles so not much blood is getting pumped with each beat.

you must understand the electrical circuit and what atrial fib is doing to the electrical circuit. the reason you want to slow atrial fib is to prevent the rebel pacemakers that are firing off in the atrium from getting their impulses through the junctional tissue. the only way that can be done is to slow the atrial fib down. the junctional tissue can't discriminate where the electrical impulse is coming from. it only knows, "here comes an electrical impulse, i have to let it through." and, unless the junctional tissue is damaged, that is exactly what it does and why you get rvr.