Atrial Fibrillation - Coursework Example

AR Atrial Fibrillation 11/20 Atrial Fibrillation Introduction Heart is the main organ of the body which pumps blood throughout the body and any defect in the heart can cause serious concerns for the patient. As I have come across my practice I happen to notice that several patients in my field are suffering from heart defects. This makes me more interested in the subject of heart and in particular the arrhythmia known as the Atrial Fibrillation. Throughout my course I have noticed that in order to become a successful advanced practice nurse I have to have a grip over subjects and hence I have decided to research on Atrial Fibrillation so that I can identify, diagnose, treat and manage the respective disorder. Atrial fibrillation is the most common occurring heart arrhythmia which draws more attention towards. It has always been a challenge to me to handle patients suffering from Atrial Fibrillation and hence the appropriate knowledge about the disorder is necessary for me to handle the patients suffering from it (Kumar et al 2005; Thakur 2001). Objectives Knowledge: - Heart disorders are common in the society and the arrhythmia Atrial fibrillation is known to the whole society because of its occurrence. Atrial fibrillation is a defect which needs to be managed and treated properly so that it does not recur in patients suffering from it. Comprehension: - Atrial Fibrillation is a problem which occurs due to the abnormality in the sinus rhythms of the atria. Being an APN I have to be able to manage it and know the processes which are important to diagnose atrial fibrillation. Application: - Atrial fibrillation is a disorder which can be managed through two important processes known as rate control or rhythm control. Both these strategies should take into consideration the importance of thrombo-embolic drugs. Analysis: - Rate control will only allow the patients to live on medications where as rhythm control will try to restore all the factors which are causing atrial fibrillation. Adopting the rhythm control as my first mean of management would prove worthy enough to avoid mistakes in management and treat the patient accordingly. Synthesis: - Atrial fibrillation is a commonly occurring arrhythmia which should be managed with intense care. In order to cure it I need to first diagnose it properly into persistent or paroxysmal atrial arrhythmia. Then I have to follow the respective management strategies to cure it. My first choice would still be rhythm control so as to control the rhythm of the atria and ventricles both. Evaluation: - I think that the rhythm control strategy can be useful enough to treat the patient but on the other hand it is not the only treatment for atrial fibrillation. Hence I should also follow other management techniques if this technique fails. Rate control is an important aspect of management which should be followed after the rhythm control strategy has failed. Pathophysiology of Atrial Fibrillation The heart is a complex organ which consists of two atria and ventricle. The heart operates through a rhythm of electrical impulses which normally originate in the sinus node. From the sinus node the impulse goes on to atrioventricular node through the intermodal pathways. From atrioventricular node the impulse enters the A-V bundle which further transmits it to the right and left bundle of Purkinje fibers which then transmit it to the whole ventricular fibers. It is known that if any of these nodes malfunctions an arrhythmia of the heart may occur. Similar is the case in Atrial fibrillation in which the conducting pathway of the impulses is disturbed. In Atrial fibrillation spontaneous impulses are reported to the atrial muscle fibers which results in spontaneous contraction of the muscle fibers and hence the atria does not contract properly to pump the blood to the ventricles. This may occur due to paroxysmal sinus node which refers to spontaneous impulses being passed from other areas than sinus nodes. As a result the ventricles also do not get proper signals from the AV Node and hence the contract irregularly. The ventricles however still have the capacity to pump blood to the body irrespective of the malfunctioning of the ventricles. This irregular heart beat on the other hand causes blood to be dumped into the ventricles and this may increase the result of clot formation. These clots can then lead to lethal strokes in the patient if not given the treatment (Guyton & Hall 2011; Fuster et al 2007). The question now arises as to why Atrial Fibrillation occurs in an individual. Atrial Fibrillation can be caused due to atrial valve lesions as this can cause the blood to be dumped into the atrium. It can also be caused due to ventricular dysfunction as this may enlarge the atrial walls because of dumping of blood in the atria and hence the conducting pathway would be elongated making it difficult for the impulses to reach the AV Node. Diabetes, Hypertension, Coronary heart disease and endocrine dysfunctions are other common causes which may lead to atrial fibrillation (Guyton & Hall 2011; Morady et al 2009). Atrial Fibrillation is one of the most common arrhythmias found in the hospitals. Approximately 2.3 million people in North America and 4.5 million in EU have been affected by atrial fibrillation. It is also noticed that the patients with atrial fibrillation have increased in the last twenty years. Viewing the current situation it can be clearly seen that atrial fibrillation is a cause of concern for the medical society and this needs to be managed properly (Fuster et al 2007). Diagnosis Atrial fibrillation in itself is not a lethal disorder but it can result in several other defects which may lead to death. It is usually seen to be asymptomatic in many patients as it tends to come and go. The patient may come with the symptom of rapid heart rate which can be checked by pulse rate of the patient, lack of breath, angina and chest palpitations. Atrial fibrillation can be confirmed by using an electro-cardiogram which measures the waves of the heart. In the electro-cardiogram P waves refers to the atrial depolarization or atrial contraction. However in atrial fibrillation it is seen that the contraction of the atria is spontaneous or not strong enough to generate a wave. When an electro-cardiogram of a patient with Atrial fibrillation is analyzed one can clearly see that the patient does not have a P wave in his ECG. This means that atria are not contracting properly. Simultaneously the physician can also notice that the QRS-T complex is normal in the ECG of these patients. The QRS complex is generated because of ventricular depolarization and the T wave is generated due to repolarization of the ventricles. However the timing QRS-T complex in the patient is irregular as the impulses are not reaching the ventricles at the specific time that they should. Measuring blood pressure, blood sugar and levels of thyroid hormones are also preliminary tests done by the physicians to diagnose Atrial Fibrillation. Lastly the physician also has to determine as to if the atrial fibrillation is paroxysmal or persistent. If a patient shows abnormal atrial contraction for around two to three days but he gets normal spontaneously he is said to be suffering from paroxysmal atrial fibrillation which is not as lethal. On the other hand if the irregular atrial contraction persists for seven days or more the patient is said to be suffering from persistent atrial fibrillation. It is recommended that a treatment is necessary when a patient is suffering from persistent Atrial Fibrillation (Morady et al 2009; Guyton & Hall 2011; Thakur 2001). Treatment As mentioned above the paroxysmal atrial fibrillation can cure by itself after remaining for a certain time however the persistent atrial fibrillation requires some form of treatment. In order to treat atrial fibrillation the underlying cause of the arrhythmia should be first rooted out. If the thyroid gland is excessively producing thyroid hormones which in turn have an effect on atrial muscles then the patient would have to undergo thyroidectomy. Similarly if the valves are malfunctioning then a valve replacement treatment would be best suited for the patient. If the patient is suffering from hypertension then drugs would be prescribed to reduce hypertension in the patients. If all these do not help then the patient may be prescribed drug treatments which are described below or they may have to undergo cardioversion. Cardioversion is a type of treatment through which the normal heart rate of the patient can be achieved. This can be either done by prescribing drugs or by a shock therapy (Guyton & Hall 2011; Thakur 2001). The shock therapy is a process through which two electrodes generate a current in the atria because of which the heart stops fibrillating for a few seconds and then if the heart is capable of generating normal impulses they may be revived in the atria. Patients with persistent atrial fibrillation have increased risk of blood clotting and hence blood thinners would be prescribed to these patients so that their blood does not clot. Warfarin is the most common medication used for the thinning of blood. Propafenone, flecainade, amiodorane and dofetilide are also prescribed to revive the normal heart beat in patients. Beta blockers can also be prescribed in this condition as it would decrease atrial fibrillation and may revive the normal heart beat in the patient. In some cases surgical ablation is also a recommended process through which the atrial fibrillation can be normalized (Page & Skanes 2005; Morady et al 2009). Management of Atrial Fibrillation Atrial fibrillation is a disorder which leads to several other lethal disorders which may cause instant death. Hence it becomes necessary to manage a patient with atrial fibrillation. Managing Atrial fibrillation involves three broad steps in which the heart rate should be monitored, embolism should be avoided, and the disturbance of rhythm should be controlled. Initially the first management step revolves around the controlling of heart rate or the rhythm of the heart. To control the rate of the heart it is necessary that the ventricles have reached the normal functioning level. Hence it basically aims to normalize the ventricular contractions irrespective of the irregular rhythms sent by the sinus node. The rhythm controlling management strategy aims to control the irregular rhythms sent by the atria or sinus node to the ventricles. Both these strategies can be adopted to manage atrial fibrillation simultaneously to check as to which strategy is successful enough. But both these management strategies do include the risk of embolism in the coronary vessels or heart because of which it is necessary that embolism is avoided while performing both these strategies. The rhythm control can be achieved through the process of cardioversion but while performing cardioversion it is important that the anti-thrombic drugs are administered to the patient. Cardioversion can either be done electrically or pharmacologically. Even after the rhythm has restored it is important that these patients are managed such that their atrial fibrillation does not recur. Thus the sinus rhythm is maintained even after atrial fibrillation occurs in these management strategies and this can be achieved by pharmacological treatments to the patients such as anti-arrhythmic drugs (Morady et al 2009; NCCC 2006; Fuster et al 2007). References Fred Morady, Hakan Oral, Aman Chugh, Frank Pelosi, Frank Bogun, Eric Good, Krit Jongnarangsin, Matthew Ebinger, and Thomas Crawford, The Treatment of Atrial Fibrillation. University of Michigan Electrophysiology Service. July 2009 Fuster, V., Rydâen, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., ... Wann, S. (August 01, 2007). ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation). European Heart Journal, 28, 16, 2046. Hall, J. E., & Guyton, A. C. (2011). Guyton and Hall textbook of medical physiology. Philadelphia, Pa: Saunders/Elsevier. Kumar, V., Abbas, A. K., Fausto, N., Robbins, S. L., & Cotran, R. S. (2005). Robbins and Cotran pathologic basis of disease. Philadelphia: Elsevier Saunders. Top of Form National Collaborating Centre for Chronic Conditions (Great Britain). (2006). Atrial fibrillation: National clinical guideline for management in primary and secondary care. London: Royal College of Physicians. Pagé, P., & Skanes, A. C. (January 01, 2005). Surgical treatment of atrial fibrillation. The Canadian Journal of Cardiology, 21. Bottom of Form Top of Form Parmet, S., Lynm, C., & Glass, R. M. (January 01, 2007). Atrial Fibrillation. Jama : the Journal of the American Medical Association, 298, 23, 2820. Thakur, R. K. (2001). Cardiac arrythmias. The Medical clinics of North America, v. 85, no. 2. Philadelphia: W.B. Saunders.Bottom of Form Read More