Cardiovascular Medicine Book

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Atrial Fibrillation Acute Management

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  1. See Also
    1. Guidelines 2000 CPR and Emergency Cardiovascular Care
    2. Atrial Fibrillation
    3. Atrial Fibrillation Anticoagulation
    4. Atrial Fibrillation Cardioversion
    5. Atrial Fibrillation Rate Control
  2. Hemodynamically Unstable
    1. Criteria
      1. Rapid Heart Rate over 150 beats per minute
      2. Symptoms or signs of cardiovascular compromise
        1. Angina Pectoris
        2. Acute Myocardial Infarction
        3. Hypotension
        4. Congestive Heart Failure
        5. Shortness of Breath
        6. Decreased Level of Consciousness
        7. Pulmonary edema
    2. Atrial Fibrillation Cardioversion
      1. Consider Adenosine 6-12 mg rapid IV (if no delay)
      2. Synchronized Shock: 100, 200, 300, 360 Joules
    3. Atrial Fibrillation Anticoagulation
      1. Coumadin for 2-3 weeks after conversion
  3. Hemodynamically Stable
    1. See Atrial Fibrillation Rate Control
    2. Atrial Fibrillation Cardioversion to sinus rhythm
      1. Atrial Fibrillation less than 48 hours
        1. Consider Heparin while considering cardioversion
        2. Consider early Atrial Fibrillation Cardioversion
      2. Atrial Fibrillation more than 48 hours
        1. Coumadin for 3 weeks before cardioversion
        2. Consider Atrial Fibrillation Cardioversion
        3. Continue Coumadin for 4 weeks after cardioversion
          1. See Atrial Fibrillation Anticoagulation
        4. Early cardioversion ok if cleared with TEE first
          1. See Atrial Fibrillation Anticoagulation
  4. References
    1. Falk (2001) N Engl J Med 344:1067
    2. Li (1998) Emerg Med Clin North Am 16:389
    3. King (2002) Am Fam Physician 66:249

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