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__NOTOC__
<div style="width: 80%;">
{| class="infobox" style="float:right;"
 
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 10px 10px 10px 10px;" cellpadding="0" cellspacing="0";
|-
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8;" align=center| {{fontcolor|#2B3B44|{{PAGENAME}} Resident Survival Guide Microchapters}}
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align=left | [[{{PAGENAME}} resident survival guide#Overview|Overview]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align=left | [[{{PAGENAME}} resident survival guide#Causes|Causes]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align=left | [[{{PAGENAME}} resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align=left | [[{{PAGENAME}} resident survival guide#Complete Diagnostic Approach|Diagnosis]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align=left | [[{{PAGENAME}} resident survival guide#Treatment|Treatment]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align=left | [[{{PAGENAME}} resident survival guide#Do's|Do's]]
|-
|-
| [[File:Siren.gif|30px|link=Atrial fibrillation resident survival guide]]|| <br> || <br>
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align=left | [[{{PAGENAME}} resident survival guide#Don'ts|Don'ts]]
| [[Atrial fibrillation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|}
|}
{{Atrial fibrillation}}
 
{{CMG}}; {{AE}} {{VR}}
__NOTOC__
{{CMG}}


==Overview==
==Overview==


Atrial fibrillation may be classified by duration of episodes, by extent of symptoms, and underlying pathophysiology. In 2014, AHA/ACC/HRS published a simplified scheme revised from the classification in 2006 ACC/AHA/ESC guideline.


==Classification==


===2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary===


* Based on the duration of episodes, AHA/ACC/HRS published a simplified classification scheme given in the table below:<ref name="JanuaryWann2014">{{cite journal|last1=January|first1=Craig T.|last2=Wann|first2=L. Samuel|last3=Alpert|first3=Joseph S.|last4=Calkins|first4=Hugh|last5=Cleveland|first5=Joseph C.|last6=Cigarroa|first6=Joaquin E.|last7=Conti|first7=Jamie B.|last8=Ellinor|first8=Patrick T.|last9=Ezekowitz|first9=Michael D.|last10=Field|first10=Michael E.|last11=Murray|first11=Katherine T.|last12=Sacco|first12=Ralph L.|last13=Stevenson|first13=William G.|last14=Tchou|first14=Patrick J.|last15=Tracy|first15=Cynthia M.|last16=Yancy|first16=Clyde W.|title=2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary|journal=Journal of the American College of Cardiology|year=2014|issn=07351097|doi=10.1016/j.jacc.2014.03.021}}</ref><ref name="Fuster-2006">{{Cite journal  | last1 = Fuster | first1 = V. | last2 = Rydén | first2 = LE. | last3 = Cannom | first3 = DS. | last4 = Crijns | first4 = HJ. | last5 = Curtis | first5 = AB. | last6 = Ellenbogen | first6 = KA. | last7 = Halperin | first7 = JL. | last8 = Le Heuzey | first8 = JY. | last9 = Kay | first9 = GN. | title = ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal = Circulation | volume = 114 | issue = 7 | pages = e257-354 | month = Aug | year = 2006 | doi = 10.1161/CIRCULATIONAHA.106.177292 | PMID = 16908781 }}</ref>
==Causes==
 
===Life Threatening Causes===
 
{{PAGENAME}} is a life-threatening condition and must be treated as such irrespective of the underlying cause.
 
===Common Causes===
 
Click '''[[{{PAGENAME}} causes|here]]''' for the complete list of causes.
 
==FIRE: Focused Initial Rapid Evaluation==
 
A Focused Initial Rapid Evaluation (FIRE) as shown below should be performed to identify patients in need of immediate intervention.
 
<span style="font-size:85%">Boxes in red signify that an urgent management is needed.</span>
 
{{Family tree/start}}
{{Family tree|border=2|boxstyle=background: #FF0000; color: #F8F8FF;| | | | | | | | | | | | | A01 | | | | | | | | | | | | | |A01=
<div style="text-align: left; height: 150px; width: 200px; padding: 5px;">
'''Symptoms & Signs''' <BR>
----
❑ Altered mental status <BR>
❑ Cyanosis <BR>
❑ Hypotension (MAP <60 mmHg)<BR>
❑ Oliguria (<0.5 mL/kg/h) <BR>
❑ Tachycardia <BR>
❑ Tachypnea
</div>}}
{{Family tree|border=0|boxstyle=background: #FF0000; color: #F8F8FF;| | | | | | | | | | | | | |!| | | | | | | | | | | | | | |}}
{{Family tree|border=0|boxstyle=background: #FF0000; color: #F8F8FF;| | | | | | | | | | | | | B01 | | | | | | | | | | | | | |B01=
<div style="text-align: center; height: 25px; width: 200px;">
'''Shock'''
</div>}}
{{Family tree|border=0|boxstyle=background: #FF0000; color: #F8F8FF;| | | | | | | | | | | | | |!| | | | | | | | | | | | | | |}}
{{Family tree|border=0|boxstyle=background: #FF0000; color: #F8F8FF;| | | | | | | | | | | | | C01 | | | | | | | | | | | | | |C01=
<div style="text-align: left; height: 520px; width: 200px; padding: 5px;">
'''Resuscitation''' <BR>
----
❑ 0.5—1 L every 10—15 minutes<sup>†</sup> <BR>
❑ ± Morphine 2—4 mg boluses <BR>
❑ Ventilatory support <BR>
'''Labs & Imaging''' <BR>
----
❑ CBC/DC/SMA-7/PT/PTT <BR>
❑ Arterial blood gas <BR>
❑ Lactate <BR>
❑ ECG <BR>
❑ CXR <BR>
❑ Echocardiography <BR>
❑ CXR <BR>
❑ Central venous catheter <BR>
❑ Pulmonary artery catheter <BR>
'''Immediate Goals''' <BR>
----
❑ MAP >60—65 mmHg <BR>
❑ CVP 8—12 mmHg <BR>
❑ PCWP 12—15 mmHg <BR>
❑ CI >2.1 L/min/m<sup>2</sup> <BR>
❑ Hemoglobin >7—9 g/dL <BR>
❑ SaO2 >90%—92% <BR>
❑ MVO2 >60% <BR>
❑ SCVO2 >70% <BR>
❑ Lactate <2.2 mM/L <BR>
❑ Urine output >0.5 mL/kg/h
</div>}}
{{Family tree|border=0|boxstyle=background: #FF0000; color: #F8F8FF;| | | | | | | | | | | | | |!| | | | | | | | | | | | | | |}}
{{Family tree|border=0|boxstyle=background: #FF0000; color: #F8F8FF;| | | | | | | | | | | | | D01 | | | | | | | | | | | | | |D01=
<div style="text-align: left; height: 130px; width: 200px;">
</div>}}
{{Family tree/end}}
 
<sup>†</sup> 100—200 mL boluses for cardiogenic shock
 
==Complete Diagnostic Approach==
 
 
 
 
==Treatment==
 
 
 
==Do's==
 
 


{| style="border: 2px solid #696969;"
==Don'ts==
| style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 160px"| '''Term''' || style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 900px" | '''Definition'''
|-
| style="font-size: 85%; padding: 0 5px; background: #F5F5F5" align=left valign=top |'''''Paroxysmal AF''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left|&nbsp;▸&nbsp;AF that terminates spontaneously or with intervention '''within 7 d of onset'''.<BR>&nbsp;▸&nbsp;Episodes may recur with variable frequency.
|-
| style="font-size: 85%; padding: 0 5px; background: #F5F5F5" align=left |'''''Persistent AF''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left|&nbsp;▸&nbsp;Continuous AF that is sustained '''>7 d'''.
|-
| style="font-size: 85%; padding: 0 5px; background: #F5F5F5" align=left |'''''Longstanding Persistent AF''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left|&nbsp;▸&nbsp;Continuous AF of '''>12 mo''' duration.
|-
| style="font-size: 85%; padding: 0 5px; background: #F5F5F5" align=left valign=top |'''''Permanent AF''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left|&nbsp;▸&nbsp;Permanent AF is used when there has been a joint decision by the patient and clinician to '''cease further attempts to restore and/or maintain sinus rhythm'''.<BR>&nbsp;▸&nbsp;Acceptance of AF represents a therapeutic attitude on the part of the patient and clinician rather than an inherent pathophysiological attribute of the AF.<BR>&nbsp;▸&nbsp;Acceptance of AF may change as symptoms, the efficacy of therapeutic interventions, and patient and clinician preferences evolve.
|-
| style="font-size: 85%; padding: 0 5px; background: #F5F5F5" align=left |'''''Nonvalvular AF''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left|&nbsp;▸&nbsp;AF in the absence of rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair.
|-
|}


===2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation===


* HRS/EHRA/ECAS definitions for types of AF are useful for standardizing reports of patient populations undergoing [[Atrial fibrillation|AF]] [[ablation]].


==References==
==References==
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{{reflist|2}}
{{reflist|2}}


[[Category:Arrhythmia]]
[[Category:Cardiology]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Electrophysiology]]
[[Category:Pulmonology]]
[[Category:Up-To-Date]]
[[Category:Emergency medicine]]
[[Category:Up-To-Date cardiology]]
[[Category:Medicine]]
[[Category:Resident survival guide]]
 
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
 
 
</div>

Revision as of 17:55, 7 April 2014

Sandbox/00001 Resident Survival Guide Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Causes

Life Threatening Causes

Sandbox/00001 is a life-threatening condition and must be treated as such irrespective of the underlying cause.

Common Causes

Click here for the complete list of causes.

FIRE: Focused Initial Rapid Evaluation

A Focused Initial Rapid Evaluation (FIRE) as shown below should be performed to identify patients in need of immediate intervention.

Boxes in red signify that an urgent management is needed.

 
 
 
 
 
 
 
 
 
 
 
 

Symptoms & Signs

❑ Altered mental status
❑ Cyanosis
❑ Hypotension (MAP <60 mmHg)
❑ Oliguria (<0.5 mL/kg/h)
❑ Tachycardia
❑ Tachypnea

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Shock

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Resuscitation

❑ 0.5—1 L every 10—15 minutes†
❑ ± Morphine 2—4 mg boluses
❑ Ventilatory support
Labs & Imaging

❑ CBC/DC/SMA-7/PT/PTT
❑ Arterial blood gas
❑ Lactate
❑ ECG
❑ CXR
❑ Echocardiography
❑ CXR
❑ Central venous catheter
❑ Pulmonary artery catheter
Immediate Goals

❑ MAP >60—65 mmHg
❑ CVP 8—12 mmHg
❑ PCWP 12—15 mmHg
❑ CI >2.1 L/min/m2
❑ Hemoglobin >7—9 g/dL
❑ SaO2 >90%—92%
❑ MVO2 >60%
❑ SCVO2 >70%
❑ Lactate <2.2 mM/L
❑ Urine output >0.5 mL/kg/h

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

† 100—200 mL boluses for cardiogenic shock

Complete Diagnostic Approach

Treatment

Do's

Don'ts

References


Template:WikiDoc Sources


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