Clinical Profile of 50 cases of Atrial Fibrillation

Girish, P V (2006) Clinical Profile of 50 cases of Atrial Fibrillation. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: Atrial fibrillation (AF) is the commonest cardiac arrhythmia, and is increasing in frequency. Atrial fibrillation is an abnormal heart rhythm during which the upper chambers of the heart beat irregularly. Normally the pacemaker of the heart generates an electrical impulse, which is conducted or carried to the lower or pumping chambers of the heart via the electrical conducting tissues of the heart. This allows a natural sequence of contraction where the upper chambers (atria) beat first, thus filling the lower chambers (ventricles). This sequence allows priming of the pumping chambers and contributes as much as 20% of the output of the heart. In atrial fibrillation, the heart’s natural pacemaker, the sinus node, no longer generates an electrical impulse. Instead electrical activity occurs irregularly throughout both left and right atria. This irregular electrical impulse is conducted erratically to the ventricles, resulting in an irregular heartbeat which may be excessively fast and vary in volume from beat to beat. The atrial electrical activity is very rapid (approximately 400 to 700 beats/min), but each electrical impulse results in the depolarization of only a small islet of atrial myocardium rather than the whole atrium. As a result, there is no contraction of the atria as a whole. Since there is no uniform atrial depolarization, there is no P wave. The chaotic electrical activity produces deflection on the ECG, referred to as fibrillatory wave. Fibrillatory waves vary in size and shape and are irregular in rhythm. Transmission of these multiple atrial impulses into the AV node is thought to occur at random, resulting in an irregular ventricular rhythm. Some impulses are conducted into, but not through, the AV node; i.e., they are blocked within the AVnode. This is a form of "concealed conduction" and is important since such nonconducted impulses contribute to the overall refractoriness of the AV node. For this reason, the ventricular rate of atrial fibrillation is often slower (averaging 160 to 180 beats/min). AIM OF THE STUDY: 1. To Study age, sex distribution and etiologic analysis of atrial fibrillation. 2. To study the symptom profile of atrial fibrillation. 3. To assess left atrial size and relation of that to permanent atrial Fibrillation. 4. To assess the incidence of Left atrial clot in cases of atrial fibrillation by Transesophageal Echo. MATERIAL AND METHODS: This study was conducted at Govt. Stanley Medical College & Hospital, Chennai. This study was conducted during the period of one year Jan 2004-December 2004, fifty cases of atrial fibrillation were included in this study. No patient had been counted twice if he or she got admitted again after discharge during the period. Atrial Fibrillation complicating cardiac failure patients, complete history and examination were done. Electrocardiographic features, chest radiography for cardiomegaly and radiography for cardiomegaly and pulmonary congestion, echocardiographic evaluation of ventricular function were noted. Atrial fibrillation complicating stroke, patients neurological examination done. CT scan brain taken and the features were noted. Stroke patients associated with atrial fibrillation the presence of thrombus in transesophageal echocardiogram also noted. In atrial fibrillation patients features of infective endocarditis clinically evaluated. In suspected patients three samples of blood culture taken one hour interval, and result noted. Presence of vegetations in the echo cardiography also noted. CONCLUSIONS: 1. AF is seen more commonly in men. 2. Mean age of the study population was 43 years. 3. Most common cause was RHD with mitral valve involvement. 4. Common presenting symptom was dyspnoea. 5. 15% of the patients with AF had significant haemodynamic instability requiring cardioversion. 6. CCF was the most common complication in 60% of patients and CVA in 14% of patients. 7. Echo revealed LA dilatation in 80% of cases. 8. LA clots were present in 14% of all cases and in 70% of pts with embolism. 9. Left atrial size more than 4cms was found to be related to permanent or persistent atrial fibrillation.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Atrial Fibrillation ; Clinical Profile ; 50 cases.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 23 Mar 2018 03:13
Last Modified: 24 Mar 2018 03:06

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