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Essentials in Primary Care Conference Wednesday, July 31, 2013 Who Develops Atrial Fibrillation Etiology/Risk factors • Structural heart disease (valvular disease) • Age (the older the more likely) • Hypertension • Pericarditis • Pulmonary Embolism • Chronic Lung Disease • Hyperthyroidism • Pneumonia • Others Bosiak M et al. Cardiol J. 2010;17:437-442. Approaches To Atrial Fibrillation 1. Identify <strong>and</strong> treat reversible causes (pneumonia, hyperthyriodism, holiday heart, etc.) 2. Workup with TSH, Metabolic Panel, Echo (LV function, rule out valvular disease), Consider Ischemia as an etiology 3. Evaluate for rate vs rhythm control 4. Stroke Prevention-Anticoagulation therapy Jan Basile, MD Atrial Fibrillation & Stroke Prevention
Essentials in Primary Care Conference Wednesday, July 31, 2013 Case… Rate vs Rhythm control? • A 68 year old currently asx male is in your office with a history of AF, hypertension <strong>and</strong> diabetes • BP 134/82 mmHg; pulse of 95 bpm with an irregularly irregular pattern. • Medications include: –Diltiazem CD 300 mg daily* –Lisinopril 40 mg daily –Metformin 500 mg twice daily –Aspirin 81 mg daily Ulimoen SR et al. Am J Cardiol. 2013:111-225-230. Rhythm Strip of A Fib with RVR RVR=rapid ventricular response Jan Basile, MD Atrial Fibrillation & Stroke Prevention
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