विवरण
Atrial fibrillation (AF) is a common cardiac arrhythmia characterized by rapid, irregular electrical activity in the atria of the heart. AF is a prevalent condition, affecting millions of individuals worldwide, and its incidence increases with age. Risk factors for AF include hypertension, aging, diabetes, heart disease, obesity, and alcohol consumption. AF can present with a wide range of symptoms, from palpitations and shortness of breath to fatigue, dizziness, and chest discomfort. AF is associated with an increased risk of stroke, heart failure, and other cardiovascular complications due to the irregular heartbeat's impact on blood flow and clot formation. Treatment strategies aim to control the heart rate and rhythm, reduce the risk of stroke with anticoagulation therapy, and address underlying causes and risk factors. In some cases, catheter ablation may be considered to treat AF by isolating or modifying the areas responsible for abnormal electrical signals. Lifestyle changes, including alcohol moderation, weight management, and stress reduction, play a crucial role in managing AF and improving overall cardiovascular health.
सारांश
- Atrial fibrillation (AFib) is a supraventricular arrhythmia characterized by uncoordinated atrial electrical activation and ineffective atrial contraction, resulting in irregular fibrillatory waves on ECG. Common causes include hypertension, coronary artery disease, rheumatic heart disease, congenital heart defects, heart failure, myocarditis, and cardiomyopathies. Systemic causes involve hyperthyroidism, obstructive sleep apnea, obesity, diabetes mellitus, chronic kidney failure, and pulmonary embolism.
- Risk factors for AFib encompass age (over 60), family history, genetics, male sex, European ancestry, air pollution, night shift work, recurrent supraventricular tachycardias, smoking, diabetes, and sedentary lifestyles. Prevalence increases with age, affecting millions globally and projected to rise significantly. AFib elevates stroke risk fivefold and mortality twofold.
- The pathophysiology involves independent foci or multiple small reentry circuits in the atria, alongside atrial muscle vulnerability due to abnormalities or fibrosis. Symptoms vary, with 25% being asymptomatic; common symptoms include palpitations, fatigue, lightheadedness, dyspnea, and angina. Clinical signs include a totally irregular pulse and variable heart sound intensity.
- AFib is classified as paroxysmal (less than 7 days), persistent (more than 7 days), long-standing persistent (more than 1 year), and permanent (refractory to cardioversion for over 1 year). Lone AFib occurs in individuals under 60 without structural heart disease. Diagnosis relies on ECG findings like absent P waves and fibrillatory waves, confirmed with ambulatory monitoring.
- Management aims to restore normal rhythm, eliminate further AFib episodes, and improve atrial contribution. Strategies involve "ABC": Avoiding stroke with anticoagulants, Better symptom management through rate or rhythm control, and Cardiovascular risk factor management. Stroke risk is assessed using the CHA2DS2-VASc score, guiding anticoagulant use.
- Anticoagulation options include vitamin K antagonists (warfarin) and non-vitamin K oral anticoagulants (NOACs). Warfarin requires INR monitoring between 2 and 3, while NOACs offer fixed dosing and rapid onset. Bleeding risk is evaluated using the HAS-BLED score. Left atrial appendage occlusion (LAAO) via surgical or percutaneous methods is considered for high-risk patients.
- Symptom management involves rate control (beta-blockers, calcium channel blockers, digoxin, amiodarone) or rhythm control (cardioversion, ablation, surgical procedures). Cardioversion can be electrical or pharmacological, often preceded by anticoagulation. Ablation procedures electrically isolate pulmonary veins using radiofrequency or cryoablation.
- Complications of AFib include thromboembolic events, heart failure, dementia, pulmonary edema, and sudden death (especially in WPW syndrome). Cardiovascular risk factor management involves addressing obesity, hypertension, diabetes, dyslipidemia, alcohol intake, and physical inactivity. Prognosis worsens with persistent or permanent AFib, advanced age, female sex, and comorbidities.
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