The following ECG is from an 85 yr old male who presented with dizziness and an abnormal gait.
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- Mean ventricular rate 60 bpm
- Irregular ventricular complexes
- Flutter / fib waves best seen in leads aVF & V1
- Early R wave transition between V1 & V2
- Subtle ST depression leads V4-6
- Flat T wave lead aVL
Considerations in atrial fibrillation There are a number of things to think about when encountering a patient with atrial fibrillation.
- Acute vs chronic
- Rate disturbance
- Rapid ventricular response
- Normal rate
- Bradycardia – may be secondary to therapy or tachy/brady syndrome
- Complication of AF
- Cardiac failure
- Thromboembolic / CVA
- Current therapy
- Complications of therapy
- Drug toxicity
- Precipitant / Causative factors
- Infection / Ischaemia / Structural / Endocrine / Metabolic
Despite being one of the commonest arrhythmia encountered in medicine there is considerable variability in the clinical management of atrial fibrillation. There are a number of international guidelines and protocols regarding AF management, including:
AF Related Calculators (links to MDCalc)
What happened ? This patient had known chronic atrial fibrillation and acute presentation was secondary to an acute embolic CVA.
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.
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