Albany Medical Review - January 2002

A 64-year-old woman with congestive heart failure
due to dilated cardiomyopathy

Monica Bhagia, MD

The EKG shows atrial fibrillation.

Atrial fibrillation is caused by many irritable atrial foci firing at rapid rates. A person with atrial fibrillation will not show clearly defined p-waves, and the rate and rhythm will be irregularly irregular. The heart rate is usually greater than 100 bpm if not rate controlled. Some of the causes for atrial fibrillation include valvular heart disease, hyperthyroidism, dilated cardiomyopathy, CHF, CAD, post CABG,and most commonly HTN. The patient can be rate controlled with beta blockers, calcium channel blockers, or digoxin. It is important to keep the patient anticoagulated with coumadin to reduce the risk of stroke. Cardioversion can be attempted if the patient has been in atrial fibrillation less than 3 days. If duration of atrial fibrillation is unclear, the patient should be anticoagulated for 4 weeks and then cardioverted. Chemical conversion can be attempted with agents like sotalol, flecainide, or amiodarone.

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30.01.2002

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