Acute atrial fibrillation

Introduction First-time atrial fibrillation and within 24 to 48 hours, called acute atrial fibrillation. Usually, the seizure can stop itself in a short time. For symptomatic symptoms, treatment should be given promptly. Atrial fibrillation, abbreviated as atrial fibrillation, is the most common persistent arrhythmia. The total incidence of atrial fibrillation is 0.4%. The incidence of atrial fibrillation increases with age, and the number of people over 75 can reach 10%. The frequency of atrial excitement in atrial fibrillation is 300~600 beats/min. The heartbeat frequency is often fast and irregular. Sometimes it can reach 100~160 beats/min. It is not only much faster than normal people's heartbeat, but also absolutely not neat, the atrium is lost. Effective shrinkage function.

Cause

Most common in rheumatic mitral stenosis, followed by coronary heart disease, hyperthyroidism, also seen in chronic constrictive pericarditis, cardiomyopathy, viral myocarditis, etc., low temperature anesthesia, chest and heart surgery, acute infection and brain A vascular accident can also be caused.

an examination

Related inspection

ECG dynamic electrocardiogram (Holter monitoring)

The rate of ventricular rate in atrial fibrillation is often between 100-160 beats / min, the rhythm is completely irregular, the heart sounds are strong, the speed is not the same, the pulse is also strong and weak, the pulse rate is less than the heartbeat in the same minute. When the ventricular rate is not too fast, the patient may have no symptoms, and when the rate is too fast, there may be palpitations, dizziness, chest tightness, shortness of breath, and the like. Atrial fibrillation reduces cardiac output by 30% and often causes cardiac insufficiency.

Inspection method: The P wave disappears on the electrocardiogram, and is replaced by an f-wave with a frequency of 350-600 beats/min, different shape and uneven spacing. The distance between QRS groups is absolutely irregular.

Atrial fibrillation can be initially diagnosed based on clinical signs and symptoms, but an electrocardiogram is required for the diagnosis. For patients with a brief episode of atrial fibrillation, dynamic electrocardiography is required.

Differential diagnosis

When atrial flutter and atrial fibrillation combined with indoor conduction block or impulse along the pre-excitation syndrome, the ventricular tachycardia and ventricular fibrillation should be compared.

(1) Atrial flutter should be differentiated from other rules of tachycardia: atrial flutter with a ventricular rate of 150 beats/min should be differentiated from sinus tachycardia and supraventricular tachycardia. Careful search for the waveform of atrial activity, and its relationship with the QRS complex, supplemented by measures to slow the conduction of the atrioventricular to expose the flutter wave, is not difficult to identify. Atrial flutter and atrial rate of 250 beats/min and atrial tachycardia with 2:1 atrioventricular block are sometimes difficult to identify.

(B) atrial fibrillation should be differentiated from other irregular arrhythmias: such as frequent premature beats, supraventricular tachycardia or atrial flutter accompanied by irregular atrioventricular block. An electrocardiogram can make a diagnosis. When atrial fibrillation is accompanied by complete bundle branch block or pre-excitation syndrome, the electrocardiogram appears to resemble ventricular tachycardia. Careful identification of atrial fibrillation, as well as significant irregularities in RR spacing, is conducive to the diagnosis of atrial fibrillation.

(C) the identification of atrial fibrillation with frequency-dependent intraventricular conduction changes and ventricular ectopic beats: individual QRS complex malformations are sometimes difficult to identify. The following points are useful for the diagnosis of ventricular ectopic beats: the malformed QRS complex has a fixed pairing distance from the previous heartbeat, followed by a longer interval, V1 single-phase or biphasic QRS (non-rSR' type) Wave group, V5S or rS type QRS complex. The following points are useful for the diagnosis of frequency-dependent intraventricular conduction changes: the ventricular rate is fast, the malformed QRS complex has no fixed distance from the previous heartbeat, and most of them are the first early QRS wave after a longer RR interval. Groups, followed by no long pauses; V1rSR'-type QRS complexes, small Q-waves in V6, and different degrees of QRS complex broadening on the same lead.

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