Atrial Fibrillation心房纤颤（英文版）.pptVIP

Atrial Fibrillation:Beyond Cardizem and Coumadin William R. Colyer, Jr., MD Resident Ground Rounds February 23, 1999 Case Presentation HPI: 47 yo WM presented with palpitations for 12 hours. Began suddenly and remained constant. No prior symptoms. Denied dizziness, CP or SOB. No other complaints. Allergies: NKDA Medications: None Case Presentation PMH: H/O paroxysmal AF 8 years ago per PCP. FH: Noncontributory SH: Smoked 1ppd for 27 years. Social EtOH. No recent increased EtOH consumption. ROS: Unremarkable Case Presentation VS: Afebrile, HR 110, RR 14, BP 128/76 Gen: WD WN WM NAD HEENT: NC, AT, PERRLA, EOMI, OP clear Neck: Supple, 2+ upstrokes bilaterally, no JVD or bruits. Case Presentation CV: S1S2 irregular. No S3S4 murmurs or rubs Pulm: Lungs CTA bilaterally Abdomen: Soft, NT, ND, BS positive Extremities: No clubbing, cyanosis or edema. Case Presentation ECG: AF. No acute ST segment or T wave changes. CXR: Normal Labs: BMP normal, TSH 2.3 Echo: EF 55%, no SWMA, all valves pliable, no MR, LA size 39. Case Presentation Impression: Atrial fibrillation without evidence of structural heart disease or obvious metabolic cause. Overview Main Goal: To help physicians become more comfortable with treatments designed to achieve sinus rhythm. Introduction AF is a common clinical condition. Not a homogeneous condition. Characterized by an irregularly irregular rhythm on exam. No p waves on ECG. RR interval often irregular. Note the RR interval may be regular if AV block or conduction system disease present. Introduction Introduction An AHA report in 1996 stated three main goals in management of AF. Epidemiology Current estimate of 2.2 million Americans with AF. Prevalence varies by age. Feinberg et al. Epidemiology Epidemiology AF results in a significant number of hospitalizations each year. AF accounted for 0.52% of discharge diagnoses in 1990 (176, 460 patients). Bialy et al. Pathophysiology Multiple wavelet theory first proposed by Moe. Nonuniform dis