A report on Atrial fibrillation

Leads aVL and aVF of an electrocardiogram showing atrial fibrillation. There are irregular intervals between heart beats. No P waves are seen and there is an erratic baseline between QRS complexes. The heart rate is about 125 beats per minute.
Normal rhythm tracing (top) Atrial fibrillation (bottom)
How a stroke can occur during atrial fibrillation
Non-modifiable risk factors (top left box) and modifiable risk factors (bottom left box) for atrial fibrillation. The main outcomes of atrial fibrillation are in the right box. BMI=Body Mass Index.
A 12-lead ECG showing atrial fibrillation at approximately 132 beats per minute
Diagram of normal sinus rhythm as seen on ECG. In atrial fibrillation the P waves, which represent depolarization of the top of the heart, are absent.
ECG of atrial fibrillation (top) and normal sinus rhythm (bottom). The purple arrow indicates a P wave, which is lost in atrial fibrillation.
3D Medical Animation still shot of Left Atrial Appendage Occlusion

Abnormal heart rhythm (arrhythmia) characterized by rapid and irregular beating of the atrial chambers of the heart.

- Atrial fibrillation
Leads aVL and aVF of an electrocardiogram showing atrial fibrillation. There are irregular intervals between heart beats. No P waves are seen and there is an erratic baseline between QRS complexes. The heart rate is about 125 beats per minute.

84 related topics with Alpha

Overall
Ventricular fibrillation (VF) showing disorganized electrical activity producing a spiked tracing on an electrocardiogram (ECG)

Arrhythmia

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Too fast or too slow.

Too fast or too slow.

Ventricular fibrillation (VF) showing disorganized electrical activity producing a spiked tracing on an electrocardiogram (ECG)
Broad classification of arrhythmias according to region of heart required to sustain the rhythm
Normal sinus rhythm, with solid black arrows pointing to normal P waves representative of normal sinus node function, followed by a pause in sinus node activity (resulting in a transient loss of heartbeats). Note that the P wave that disrupts the pause (indicated by the dashed arrow) does not look like the previous (normal) P waves – this last P wave is arising from a different part of the atrium, representing an escape rhythm.

Supraventricular tachycardias include atrial fibrillation, atrial flutter and paroxysmal supraventricular tachycardia.

A man with congestive heart failure and marked jugular venous distension. External jugular vein marked by an arrow.

Heart failure

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Set of manifestations caused by the failure of the heart's function as a pump supporting the blood flow through the body.

Set of manifestations caused by the failure of the heart's function as a pump supporting the blood flow through the body.

A man with congestive heart failure and marked jugular venous distension. External jugular vein marked by an arrow.
Signs and symptoms of severe heart failure
Severe peripheral pitting edema
Kerley B lines in acute cardiac decompensation. The short, horizontal lines can be found everywhere in the right lung.
Model of a normal heart (left); and a weakened heart, with over-stretched muscle and dilation of left ventricle (right); both during diastole
Chest radiograph of a lung with distinct Kerley B lines, as well as an enlarged heart (as shown by an increased cardiothoracic ratio, cephalization of pulmonary veins, and minor pleural effusion as seen for example in the right horizontal fissure. Yet, no obvious lung edema is seen. Overall, this indicates intermediate severity (stage II) heart failure.
Siderophages (one indicated by white arrow) and pulmonary congestion, indicating left congestive heart failure
Ultrasound showing severe systolic heart failure
Congestive heart failure with small bilateral effusions
Kerley B lines

Common causes of heart failure include coronary artery disease, including a previous myocardial infarction (heart attack), high blood pressure, atrial fibrillation, valvular heart disease, excess alcohol use, infection, and cardiomyopathy of an unknown cause.

CT scan of the brain showing a prior right-sided ischemic stroke from blockage of an artery. Changes on a CT may not be visible early on.

Stroke

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Medical condition in which poor blood flow to the brain causes cell death.

Medical condition in which poor blood flow to the brain causes cell death.

CT scan of the brain showing a prior right-sided ischemic stroke from blockage of an artery. Changes on a CT may not be visible early on.
There are two main categories of strokes. Ischemic (top), typically caused by a blood clot in an artery (1a) resulting in brain death to the affected area (2a). Hemorrhagic (bottom), caused by blood leaking into or around the brain from a ruptured blood vessel (1b) allowing blood to pool in the affected area (2b) thus increasing the pressure on the brain.
A slice of brain from the autopsy of a person who had an acute middle cerebral artery (MCA) stroke
CT scan of an intraparenchymal bleed (bottom arrow) with surrounding edema (top arrow)
Illustration of an embolic stroke, showing a blockage lodged in a blood vessel.
Histopathology at high magnification of a normal neuron, and an ischemic stroke at approximately 24 hours on H&E stain: The neurons become hypereosinophilic and there is an infiltrate of neutrophils. There is slight edema and loss of normal architecture in the surrounding neuropil.
A CT showing early signs of a middle cerebral artery stroke with loss of definition of the gyri and grey white boundary
Dens media sign in a patient with middle cerebral artery infarction shown on the left. Right image after 7 hours.
12-lead ECG of a patient with a stroke, showing large deeply inverted T-waves. Various ECG changes may occur in people with strokes and other brain disorders.
Walking with an orthosis after a stroke
Stroke deaths per million persons in 2012
Hippocrates first described the sudden paralysis that is often associated with stroke.

Other risk factors include high blood cholesterol, tobacco smoking, obesity, diabetes mellitus, a previous TIA, end-stage kidney disease, and atrial fibrillation.

ECG of a heart in normal sinus rhythm

Electrocardiography

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Process of producing an electrocardiogram , a recording of the heart's electrical activity.

Process of producing an electrocardiogram , a recording of the heart's electrical activity.

ECG of a heart in normal sinus rhythm
Normal 12-lead ECG
A 12-lead ECG of a 26-year-old male with an incomplete right bundle branch block (RBBB)
A patient undergoing an ECG
An EKG electrode
Proper placement of the limb electrodes. The limb electrodes can be far down on the limbs or close to the hips/shoulders as long as they are placed symmetrically.
Placement of the precordial electrodes
The limb leads and augmented limb leads (Wilson's central terminal is used as the negative pole for the latter in this representation)
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Diagram showing the contiguous leads in the same color in the standard 12-lead layout
QRS is upright in a lead when its axis is aligned with that lead's vector
Schematic representation of a normal ECG
Measuring time and voltage with ECG graph paper
Animation of a normal ECG wave
Formation of limb waveforms during a pulse
An early commercial ECG device (1911)
ECG from 1957
Use of real time monitoring of the heart in an intensive care unit in a German hospital (2015), the monitoring screen above the patient displaying an electrocardiogram and various values of parameters of the heart like heart rate and blood pressure
A 12-lead ECG of a 26-year-old male with an incomplete right bundle branch block (RBBB)

Changes in the normal ECG pattern occur in numerous cardiac abnormalities, including cardiac rhythm disturbances (such as atrial fibrillation and ventricular tachycardia ), inadequate coronary artery blood flow (such as myocardial ischemia and myocardial infarction ), and electrolyte disturbances (such as hypokalemia and hyperkalemia ).

Atrial flutter with varying A-V conduction (5:1 and 4:1)

Atrial flutter

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Common abnormal heart rhythm that starts in the atrial chambers of the heart.

Common abnormal heart rhythm that starts in the atrial chambers of the heart.

Atrial flutter with varying A-V conduction (5:1 and 4:1)
Type I atrial flutter, counterclockwise rotation with 3:1 and 4:1 AV nodal block.
Atrial flutter with a two to one block. Note the P waves hiding in the T waves in leads V1 and V2

It is typically not a stable rhythm, and often degenerates into atrial fibrillation (AF).

Lead II electrocardiogram strip showing PSVT with a heart rate of about 180.

Supraventricular tachycardia

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Umbrella term for fast heart rhythms arising from the upper part of the heart.

Umbrella term for fast heart rhythms arising from the upper part of the heart.

Lead II electrocardiogram strip showing PSVT with a heart rate of about 180.
Mechanisms of supraventricular tachycardias
Holter monitor-Imaging with start (red arrow) and end (blue arrow) of a SV-tachycardia with a pulse frequency of about 128/min.
A 12-lead ECG showing paroxysmal supraventricular tachycardia at about 180 beats per minute.
Atrial fibrillation: Red dots show atrial fibrillation activity.
Impulse arising in SA node, traversing atria to AV node, then entering ventricle. Rhythm originating at or above AV node constitutes SVT.
Atrial fibrillation: Irregular impulses reaching AV node, only some being transmitted.

There are four main types of SVT: atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), and Wolff–Parkinson–White syndrome.

ECG showing sinus tachycardia with a rate of about 100 beats per minute

Tachycardia

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Heart rate that exceeds the normal resting rate.

Heart rate that exceeds the normal resting rate.

ECG showing sinus tachycardia with a rate of about 100 beats per minute
12 lead electrocardiogram showing a ventricular tachycardia (VT)

Atrial fibrillation

Artistic impression of a woman experiencing syncope, which may be accompanied by heart palpitations

Palpitations

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Further characterized by the hard, fast and/or irregular beatings of the heart.

Further characterized by the hard, fast and/or irregular beatings of the heart.

Artistic impression of a woman experiencing syncope, which may be accompanied by heart palpitations

Three common descriptions of palpitation are "flip-flopping" (or "stop and start"), often caused by premature contraction of the atrium or ventricle, with the perceived "stop" from the pause following the contraction, and the "start" from the subsequent forceful contraction; rapid "fluttering in the chest", with regular "fluttering" suggesting supraventricular or ventricular arrhythmias (including sinus tachycardia) and irregular "fluttering" suggesting atrial fibrillation, atrial flutter, or tachycardia with variable block; and "pounding in the neck" or neck pulsations, often due to cannon A waves in the jugular venous, pulsations that occur when the right atrium contracts against a closed tricuspid valve.

Warfarin

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Medication that is used as an anticoagulant .

Medication that is used as an anticoagulant .

Vitamin K1-warfarin interaction effect. When warfarin levels are high, people have more risk of bleeding. Conversely, lower levels of warfarin lead to increased risk of blood clots. There is a narrow range where the benefits of warfarin are greater than the risks, its therapeutic window. Certain drugs, herbal medicines, and foods can interact with warfarin, increasing or decreasing a previously stable warfarin level.
Acyclic tautomer (left) and cyclic hemiketal tautomer (right)
3 mg (blue), 5 mg (pink) and 1 mg (brown) warfarin tablets (UK colours)
Warning label on a tube of rat poison laid on a dike of the Scheldt river in Steendorp, Belgium. The tube contains bromadiolone, a second-generation ("super-warfarin") anticoagulant.

It is commonly used to prevent blood clots such as deep vein thrombosis and pulmonary embolism, and to prevent stroke in people who have atrial fibrillation, valvular heart disease or artificial heart valves.

Automated arm blood pressure meter showing arterial hypertension (shown by a systolic blood pressure 158 mmHg, diastolic blood pressure 99 mmHg and heart rate of 80 beats per minute)

Hypertension

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Long-term medical condition in which the blood pressure in the arteries is persistently elevated.

Long-term medical condition in which the blood pressure in the arteries is persistently elevated.

Automated arm blood pressure meter showing arterial hypertension (shown by a systolic blood pressure 158 mmHg, diastolic blood pressure 99 mmHg and heart rate of 80 beats per minute)
Determinants of mean arterial pressure
Illustration depicting the effects of high blood pressure
Rates of hypertension in adult men in 2014.
Diagram illustrating the main complications of persistent high blood pressure
Image of veins from Harvey's Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus
Graph showing, prevalence of awareness, treatment and control of hypertension compared between the four studies of NHANES

Long-term high blood pressure, however, is a major risk factor for stroke, coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and dementia.