Atrial Fibrillation

AFib, The Basics

  1. irregularly iregular
  2. irregular RR intervals
  3. not a P wave in front of every QRS
  4. atrial rate = 400-600bpm, ventricular rate = 80-160bpm
Etiologies = PIRATES
P = pulmonary (COPD, PE)/pheo/pericarditis
I = ischemic heart dz +/- HTN
R = rheumatic heart dz
A= anemia/atrial myxoma
T = throtoxicosis
E = ethanol ("holiday heart)/cocaine
S = sepsis (post-operative)

  1. fatigue (most common)
  2. tachypnea
  3. palpitations
  4. lightheaded

Work Up
(Test yourself... why would you order each of these? what are you looking for?) - answers below
  1. EKG
  2. ECHO
  3. TSH (?)
  4. Baseline coags

  1. EKG = narrow complex QRS (<120msec), variable RR, irregular or absent P waves
  2. ECHO = maybe thrombi, maybe dilated L atrium
  3. TSH (?) = hyperthyroidism can cause AF
  4. Baseline coags = getting baseline prior to starting anticoagulation

Of note: if you are looking for THROMBI..."normal" ECHOs (transthoracic) has low sensitivity - transesophageal ECHOs allow for better visualization of L atrial appendage (location where most thrombi form) 

source: First Aid for the Wards by Le, Bhushan, Skapik
pic source: http://www.saintvincenthealth.com/Services/Heart/Heart-Resource-Library/Atrial-Fibrillation/default.aspx


  1. Thanks for the tips

    1. No problem! Let me know if you are looking for a specific topic!

  2. Ms. Belcher, excellent blog site! Your data is well outlined, terrific explanations. Depth and Breadth of material covered gives your readers a wide variety of material to review. As a Physician Assistant in the Dept of Emergency Medicine for nearly 30 years, I find myself reviewing for my ER Board exams, and NCCPA recerts; your site has a wealth of information on which to start my reviews. And as a Clinical Instructor and Preceptor at UCLA/UCR School of Medicine, Instructor at RCC Dept of medical sciences Emergency Medicine, I am pleased to refer my students to your blog. I look forward to your continued updates, new information that is applicable to today's ever changing world of medicine.

    Gregory M. Chase, MSHED, MS, PA-C
    Department of Emergency Medicine
    Los Angeles, California

    1. Gregory,
      Thank you for the kind words and comments. Congrats on 30 years of ED service and best of luck on the recertification!