ECG I



Fig. 17.1
EKG obtained in the postoperative period



A 76-year-old female patient is in the postanesthesia care unit after an ORIF of an acetabular fracture. She underwent general anesthesia with an uneventful surgical procedure. You have been called to evaluate the rhythm above (Fig. 17.1).

Pulse 136, BP 110/50, and SpO2 97% on 2 L O2 via nasal cannula

NKDA

Medical history: hypertension (takes amlodipine for it).

Preoperative vital signs

SpO2 98%, blood pressure 140/90, HR 96, temp 36.4, EKG normal sinus rhythm, normal transthoracic echocardiogram.




  1. 1.


    How would you describe this rhythm?

     

  2. 2.


    Name and define different types (based on occurrence and duration) of the arrhythmia shown above.

     

  3. 3.


    What is the incidence in the general population? What is the incidence after cardiothoracic surgery and after non-cardiac surgery?

     

  4. 4.


    How would you treat this patient?

     

  5. 5.


    What concerns are there whenever a patient with persistent AF is cardioverted?

     

  6. 6.


    What are precipitants of postoperative atrial fibrillation?

     

  7. 7.


    What are the CHADS2 and CHA2DS2-VASc scores?

     

  8. 8.


    Is there any relation between neuraxial anesthesia and atrial fibrillation?

     

  9. 9.


    How does the treatment for Wolff-Parkinson-White syndrome with preexcitation AF differ from atrial fibrillation alone?

     



Answers


  1. 1.


    This rhythm is atrial fibrillation (AF) with a rapid ventricular response. The pattern is irregularly irregular. The rhythm strip has no distinct p wave but instead many f waves (also known as fibrillary waves) followed intermittently by narrow QRS complexes.

     

  2. 2.


    Lone atrial fibrillation—An outdated term also known as idiopathic atrial fibrillation. It originally meant atrial fibrillation that occurs in a person 40 years or younger without intrinsic cardiac disease [1].

    Paroxysmal atrial fibrillation—AF that occurs spontaneously, lasts less than a week, and occurs at variable frequency [2].

    Persistent atrial fibrillation—Atrial fibrillation that lasts longer than 7 days. It may go away on its own or resolve with treatment [2].

    Long-standing persistent atrial fibrillation—AF lasting longer than 12 months [2].

    Permanent atrial fibrillation—more of a therapeutic decision between the patient and clinician to stop attempting to treat AF for conversion to sinus rhythm [2].

     

  3. 3.


    Atrial fibrillation is the most common heart arrhythmia. It affects an estimated 2.7–6.1 million people in the United States. About 2% of people over the age of 45 have atrial fibrillation, while 9% of people greater than age 65 have it. It is more likely after cardiac surgery and can affect from 10% to 65% of patients after cardiac surgery. AF is rare after non-cardiac surgery and can affect about 1–3% of the patients. Patients who develop postoperative atrial fibrillation have higher morbidity and mortality rates and have higher costs of care.

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Sep 23, 2017 | Posted by in Uncategorized | Comments Off on ECG I
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