Irregularly irregular heart rate that may be extremely fast (e.g.AF with an accessory pathway produces a fairly distinctive pattern of EKG findings:.This is dangerous because the extremely fast and uncoordinated contractions of the ventricle can promote ventricular tachycardia or cardiovascular collapse. (1) Heart rate: As a general rule, heart rates 200).Some key pieces of information can help:.The key question is: What is driving the instability? Is the atrial fibrillation causing the patient to be unstable? Or is atrial fibrillation merely triggered by underlying instability?.How much is AF actually contributing to the patient's instability? TSH should be considered if there is no obvious cause of AF, or if other clinical features suggest thyrotoxicosis.If there is other evidence suggesting PE, CT angiography may be indicated.If thoughtful review of EKG and history suggests ischemia, then obtain troponin.Additional tests as clinically warranted.Review of the presence of any indwelling cardiac devices.Pneumonia, COPD, hypoxemia, hypercapnia.Primary neurologic disorders (e.g., intracranial hemorrhage, ischemic stroke).
Beta-agonists (norepinephrine, epinephrine, dobutamine, etc.).Substance use (especially cocaine, amphetamine, methamphetamine).Electrolyte abnormalities (especially hypokalemia and hypomagnesemia).Be careful when cardioverting patients with a heart rate If the heart rate is
FLUTTER MEANING MEDICAL PLUS
If the heart rate is >200, consider the possibility of an accessory tract (AF plus Wolff Parkinson White).For most patients who aren't on medications that suppress the AV node, AF will have a heart rate of ~120-180.(One exception to these criteria is that if AF is combined with heart block, then the ventricular response may be regular.).Also consider comparison to P wave morphology in prior EKGs (if the patient previously had large, well-defined P-waves and now they're gone, then this supports an AF diagnosis). If it is unclear whether there are P waves or fibrillation waves, consider obtaining a Lewis Lead EKG.In some patients, fibrillation waves may be small and difficult to distinguish from artifact.Fibrillation waves may be best seen in the inferior and right-sided precordial leads.No P waves are seen instead these may be replaced by fibrillation waves.When in doubt, calipers may help determine whether there is any regularity.At very high rates, the heart rate may appear to be regular (“pseudo-regularization”).
FLUTTER MEANING MEDICAL FULL
0 kommentar(er)
