Episode 20: Atrial Fibrillation

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 10 February 2012

⏱️ 89 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode Dr. Clare Atzema, Dr. Nazanin Meshkat and Dr. Bryan Au discuss the presentation, etiology, precipitants, management and disposition of Atrial Fibrillation in the Emergency Department. The pros and cons of rate and rhythm control are debated, what you need to know about rate and rhythm control medications reviewed, and the strength of the Ottawa Aggressive Protocol discussed. The importance of appropriate anticoagulation is detailed, with a review of the CHADS-VASc score and whether to use Warfarin, Dabigatran or ASA for stroke prevention for patient with Atrial Fibrillation. We end off with a discussion on how to recognize and treat Wolff-Parkinson-White syndrome in the setting of Atrial Fibrillation.

Transcript

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0:00.0	Welcome to Emergency Medicine Cases.com.
0:05.1	I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.
0:14.5	On this episode number 20 on atrial fibrillation, we have with us Dr. Nazanin-Meshcat, Dr. Claire at Zemma, and Dr. Brian Now.
0:20.7	Dr. Meskart is an emergency physician at the University Health Network in York Central Hospital in Toronto. She's an assistant professor at the University of Toronto and a consultant at the Center for Innovation in Complex Care. Dr. Claretszema is an emergency physician at Sunnybrook Health Sciences Center in Toronto. She's an adjunct scientist with the Institute for Clinical Evaliative Sciences
0:37.8	and Assistant Professor at the Department of Medicine at the University of Toronto. Dr. Brian
0:42.2	Now is an emergency physician at St. Michael's Hospital in Toronto and an assistant professor
0:46.0	at the University of Toronto. He's a well-known speaker in emergency medicine and is the recipient
0:50.2	of multiple teaching awards.
0:53.2	A-fib is the most common dysrhythmia seen in the ED, and its incidence is increasing as the population ages.
1:00.0	We often see a-fib in association with other diseases. It may signify an underlying disease like hypothyroidism,
1:06.0	or maybe a result of structural heart disease, for example.
1:09.0	The presence of A-fib has an independent association with mortality and heart disease, for example. The presence of AFIB has an independent
1:11.4	association with mortality and heart failure, as well as a well-known risk for thrombolic events
1:17.0	due to stasis of blood flow in the left atrium. In fact, about 15% of all strokes in North America
1:22.6	are due to AFIB. Most patients with AFIB can be safely managed in the ED without need for hospital
1:29.0	admission. However, there's a huge variability in practice when it comes to exactly how these patients
1:34.5	should be managed in the ED. Should the patient be rate controlled or rhythm controlled? If they're
1:40.8	cardioverted, should we be using meds or electricity or both?
1:45.1	Should they be anticoagulated in the ED?
1:48.4	What meds should they be sent home on?
1:50.5	Which patients should be admitted to hospital?
1:53.0	With the help of Dr. Awe, Meskat, and Atzima will help clarify the best management options
	...

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