Atrial Fibrillation in Clinical Practice Essay

Cardiac dysrhythmia or arrhythmia is a condition in which the heart experiences abnormal pulse rhythms. Atrial fibrillation (AF) is among the most frequent types of cardiac arrhythmia, which has affected 33 million people across the globe (Estes & Waldo, 2015). AF as a risk factor infected 2-4% of the Australian population and caused the deaths of 2,326 individuals in 2016 (Australian Bureau of Statistics, 2017). A study by DeVore et al. (2016) showed that 4% of the patients admitted to hospital had atrial fibrillation. The frequency of ischemic stroke among people with atrial fibrillation increases with age (Bjorck, Palaszewski, Friberg, & Bergfeldt, 2013). As a result, AF is becoming a hazardous disease to the modern society due to the increasing aging populace (Elliott, 2018). It is critically important to build up the pathophysiological knowledge of AF and understand the complications in the clinical practice to provide appropriate care and management to optimize patients' outcome. This essay will focus on the pathophysiology of atrial fibrillation and the underlying cause of complications, treatment option, and its nursing care management.

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According to McCance and Huether (2014), the standard conduction system of the heart starts from the sinoatrial (SA) to atrioventricular (AV) node via various intra-arterial pathways, which facilitate atrial myocardium contract. The, AV nodes send impulses to the left and right bundle branch through the bundle of His and finally down to Purkinje fibers to enhance ventricular myocardium contraction. McCance and Huether (2014) state that cardiac arrhythmia can be caused by abnormal impulse generation leading to irregular and rapid heartbeats, usually 100-160 pulses per minute. During atrial fibrillation condition, SA node loses organized signal creation as the pacemaker, the electrical impulses are in disarray, and generating their own way to AV node making it receive the pulses erratically. The heart muscles of atrium fail to contract uniformly; therefore its systematic mechanical contraction is disturbed, and cardiac rhythm becomes irregular.

There are various complications associated with atrial fibrillation, such as myocardial infarction, hypertension, heart failure, and the main signs include abnormal palpitations, dyspnoea (breathlessness), chest tightness, and fatigue (Kirchhof et al., 2017). The most common and severe complications of AF are thrombi formation, heart failure.

As stated above, the standard conduction system requires regular unified electrical impulses spreading sequentially to contact myocardium to pump out all the blood from the atrium to ventricle, and then out of all ventricles. When AF occurs, the cardiac conduction system is disorderly; the components of the system begin their conductive impulses which pump all the blood out of atrium to ventricles (Elliott, 2018). However, there is some blood that remains static in the atria which increases the risks of forming clots. Once they are formed, the heart pumps them to the whole body through the bloodstream. If the clots travel from the right ventricle to the lungs, they might cause pulmonary embolism depending on the size of the thrombi. As a result, the blood oxygenation and deoxygenation process is significantly affected. There are high chances of someone suffering from a stroke if the clots move to the brain and block the arteries. Circulation of the blood containing lumps in the in the arteries leads to narrowing of the pathways or blockage limiting circulation.

Heart Failure occurrences increase as atrial fibrillation is persistent without any control. This disorder to a great extent affects the circulation in the blood system. Consequently, the heart is unable to pump blood efficiently leading to inadequate supply due to partial blood remaining in the atrium. According to McCance and Huether (2014), heart failure refers to the inability of the heart to generate adequate cardiac output and perfusion of tissues. The heart requires a sufficient supply of blood which is facilitated by the coronary artery. Insufficient supply of blood to the heart weakens it, and in turn, the pumping is significantly affected. This risk increases over time, the heart functions abnormally, and starts to send a signal to make the body aware. The chest tightness and palpitation can be felt. Likewise, insufficient blood supply to the lungs can cause shortness of breath. Thus, persistent limited blood supply without intervention eventually lead to heart failure which contributes to body tiredness, fatigue, and unusual palpitations.

There are various interventions which may help the patient in case atrial fibrillation. Van Gelder, Rienstra, Crijns, & Olshansky (2016) stated that the goals of AF treatment are "rate control" and "rhythm control", and can be done together. Maintaining a normal heart rate is an effective way to reduce tachycardia-induced cardiomyopathy which is caused by AF and consequently minimizes the risk of heart failure (Van Gelder et al., 2016). Beta blockers and diltiazem hydrochloride are effective drugs to slow heart rate. Besides, cardiac glycosides digoxin can be used as additional medicine to control heart rate (Elliott, 2018). Beta blockers, such as propranolol and metoprolol can reduce the cardiac output, myocardial demand, heart rate, and blood pressure (Tiziani & Havard, 2013). Calcium channel blockers such as diltiazem and felodipine are also useful in reducing pulse rate via decreased conduction at AV node. Besides, they minimize myocardial contraction.

References

Australian Bureau of Statistics. (2017). Causes of Death 2015, Retrieved from:

Bjorck, S., Palaszewski, B., Friberg, L., & Bergfeldt, L. (2013). Atrial Fibrillation, Stroke Risk, and Warfarin Therapy Revisited: A Population-Based Study. Stroke, 44(11), 3103-3108. doi: 10.1161/strokeaha.113.002329

DeVore, A., Hellkamp, A., Becker, R., Berkowitz, S., Breithardt, G., & Hacke, W. et al. (2016). Hospitalizations in patients with atrial fibrillation: an analysis from ROCKET AF. Europace, 18(8), 1135-1142. doi: 10.1093/europace/euv404

Elliott, K. (2018). Diagnosis and management of patients with atrial fibrillation. Nursing Standard, 33(2), 43-49. doi: 10.7748/ns.2018.e11077

Estes, N. A. M., III, & Waldo, A. L. (2015). Atrial fibrillation : a multidisciplinary approach to improving patient outcomes. Minneapolis : CardioText, [2015]. Minnesota, USA: Casdiotext publishing.

http://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/3303.0~2015~Main% 0Features~Stroke~10003

Kirchhof, P. et al., (2017). Corrigendum to: 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal, 39(13), 1109-1109. doi: 10.1093/eurheartj/ehx039

McCance, K. L., & Huether, S. E. (2014). Pathophysiology : The Biologic Basis for Disease in Adults and Children. Saint Louis : Elsevier Health Sciences.

Tiziani, A., & Havard, M. (2013). Havard's nursing guide to drugs. Chatswood, N.S.W. : Elsevier Australia.

Van Gelder, I., Rienstra, M., Crijns, H., & Olshansky, B. (2016). Rate control in atrial fibrillation. The Lancet, 388(10046), 818-828. doi: 10.1016/s0140-6736(16)31258-2