EKG Interpretation Pt 2: Effective Management of A-Fib

Whether you’re working in a hospital or currently doing your clinical, there will be instances that you will encounter clients who will have atrial fibrillation. To manage atrial fibrillation effectively, you must first get acquainted with what it is and what mainly causes it.  

Causes of Atrial Fibrillation

Before treating atrial fibrillation, you should first know what caused the condition. What are some of these causes?

1. Ischemia

Ischemia is decreased oxygenation to the heart. Ischemia usually happens with myocardial infarction which is mainly caused by decreased oxygen levels of the heart; this then can lead to necrosis.

Lung disease is another viable reason for ischemia; this is because of the decreased oxygen going inside the lungs that can deliberately affect how the heart receives oxygen. Remember, very little, or no oxygen at all will lead to organ failure and eventually, death.

2. Valve disease

Diseases concerning the heart valves primarily result in the chambers’ inability to open and close at a certain period. When this happens, it can adversely affect the heart because if there are not enough succinct pumps going to the heart, it will result in the decreased cardiac output.

We’ve discussed cardiac output in our previous lectures. To jog your memory, cardiac output is the amount of blood pumped by the heart in a whole minute. If the heart is not contracting efficiently, it is not filled adequately, and the contractions will fail as well.

Without a normal cardiac output, the body will not receive a satisfactory amount of blood and oxygen that are mainly required for proper functioning.

3. Atrium Problems

When there are issues concerning the atriums of the heart, blood will not be pushed down all the way to the ventricles because the atriums are not contracting properly. There will be minor contractions, but they are not enough to sustain the needs of the heart.

The Atrial Kick

What is an atrial kick? How does one interpret an atrial kick once it’s encountered?

You can think of an atrial kick as someone slamming the door and pushing blood forcefully into the ventricles, slamming the valve shut.

An atrial kick is also similar to packing suitcases wherein you have to try to fill it in with items, then kick the overflowing clothes inside the bag so that you can zip them all in. In atrial fibrillation, this zip-kick motion is almost non-existent.

Formation of Clots

If the chamber is full of blood, it starts pooling in the atriums. Pooling will cause the blood to eventually dry up and start forming fibrinogen and fibrin which is also known as a clot. Clot formation will block the atriums entirely or will be sent out to the system as tiny clots which are the main causes of cerebrovascular accident (CVA), myocardial infarction (MI), or deep vein thrombosis (DVT).

Clots are deadly enough to shut down the lungs in a condition known as pulmonary embolism (PE).

Managing Atrial Fibrillation

How does one combat clot and other issues that cause atrial fibrillation?

1. Warfarin (Coumadin) treatment is given to thin out blood over long periods of time which leads to de-coagulation. Plavix, an anti-platelet congregator is also given.
2. A positive inotrope to make the atriums contract better is also used. Inotropes are concerned with the contractility force, and one popular example is Digoxin. Digoxin is a cardiac glycoside that helps with the heart’s atrial kick.
3. Amiodarone is a used to slow down dysrhythmia, helping the heart contract succinctly and eliminating sporadic contractions.
4. Calcium channel blockers help the blood vessels and the muscles of the heart to relax. By blocking calcium, excitability is reduced. Increased excitement due to calcium deposits in the heart can lead to its stiffening. The goal is to achieve a soft, supple heart that contracts normally and is relaxed.
5. Oxygen is given for obvious reasons.
6. Electrical cardioversion is also given to restart the SA node.

Remember, the main goal when managing a client with atrial fibrillation is to make the atrium contract efficiently and prevent clot formation from happening.

In our following lecture, we will discuss what atrial flutter is. For other nursing-related lectures, just drop by SimpleNursing.com.