Part 3 Engine of the heart-AFIB and RVR

After reviewing the anatomy and physiology of the human heart and seeing how it functions with the lungs, and blood for carrying oxygen and dispensing carbon dioxide from other areas of the human body to ending spot the lungs in exhaling, now lets learn how cardiac disease effects the heart to function in doing this process.  Today lets talk about atrial fibrillation and Rapid Ventricular Rate/Response.

Some people in the US have this cardiac condition called Atrial Fibrillation where some with this condition even experience Rapid Ventricular Rate or Response with it.

Atrial fibrillation is an irregular and often rapid heart rate that commonly causes poor blood flow to the body.

During atrial fibrillation, the heart’s two upper chambers (the atria) beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart causing your pulse to be irregular. We know now how the blood flows through the heart but due to the irregularity of the atriums which is not allowing the chambers to fill up to the maximal level they normally did when they didn’t have Atrial Fibrillation is decreasing the cardiac output (blood volume) from the left ventricle to be decreased.   This means the heart and all other tissuesaren’t getting the regular amount of oxygen they got when they were in a regular normal rhythm.  Atrial fibrillation symptoms often include heart palpitations, shortness of breath and weakness.  Atrial fibrillation (also called AFib or AF) is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure and other heart-related complications. Some people refer to AF as a quivering heart.  What happens here is primarily the ventricles take over.   With the atriums quivering and the ventricles going at their rate this causes an irregular heart rate HR.  Another problem with an irregular heart rate is this allows blood to pool in the heart putting the patient at risk for clot formation.  As this HR gets more irregular it puts the patient at a higher risk of allowing the clot to break off inside the heart now flowing freely in the blood stream.  If it reaches the lungs and stays there a pulmonary thrombus can occur causing breathing difficulties; if it bypasses the lungs the next place it goes to is the brain putting the person at risk for a stroke and if it reaches back to the heart the patient can have a heart attack.  This why you commonly see patients with atrial fibrillation on the med Coumadin or some form of anticoagulant drug to prevent clots from occurring.

An estimated 2.7 million Americans are living with Afib.

Episodes of atrial fibrillation can come and go, or you may develop atrial fibrillation that doesn’t go away and may require treatment. Although atrial fibrillation itself usually isn’t life-threatening, it is a serious medical condition that sometimes requires emergency treatment. It can lead to complications. Atrial fibrillation may lead to blood clots forming in the heart that may circulate to other organs and lead to blocked blood flow (ischemia) to even stroke/heart attack to pulmonary thrombus as stated earlier.

Treatments for atrial fibrillation may include medications like anticoagulants primarily=usually Coumadin,  antiplatelets= aspirin (platelets are responsible for clotting in our bloodstream) with and other interventions to try to alter the heart’s electrical system such as cardioversion-shocking the heart at low level voltage, more common in newly diagnosed afib. in hope to knock the afib into a regular rhythm called normal sinus rhythm (the best rhythm to be in).

Various studies have reported that electrical cardioversion is over 90 percent effective in converting to a normal sinus rhythm though many people revert back into afib shortly thereafter. Success has been shown to be enhanced when patients are on an antiarrhythmic drug beforehand, which helps prevent reverting back to atrial fibrillation.

Success depends on the size of the left atrium as well as how long the patient has been in afib. Patients with a very large left atrium, one greater than 5 cm, or who have been in constant afib for a year or two, may find that electrical cardioversion is not effective in converting to or maintaining a normal sinus rhythm.

Following a successful electrical cardioversion, the goal is to maintain a normal sinus rhythm, which only happens with about 20–30 percent of patients within the first year if they are not on antiarrhythmic drugs for rhythm control. Overall, the likelihood is quite high that you will revert back into atrial fibrillation, regardless of whether you stay on rhythm control drugs.

When the ventricles beat too rapidly they don’t fill completely with blood from the atria. As a result, they cannot efficiently pump blood out to meet the needs of the body. This can ultimately lead to heart failure in time if not treated.  Just like us running from NY to California most will end up not being able to do it just like the heart can’t run in atrial fibrillation in a high heart rate for a long time,  it also will give out going into failure.  The heart can only compensate in atrial fibrillation in a rapid high heart rate for so long.

A cardiac condition called Rapid Ventricular Rate or Response which is seen sometimes with Atrial Fibrillation which is the heart is overloaded.  Our heart beats lub dub which is first the atriums opening and closing (lub) and than the ventricles opening and closing (dub).  When the heart gets overworked and tries to compensate the atriums can give up and just allow the ventricles to take over to beat which affects the heart and all other tissues to get proper amount of blood with oxygen in time.  Since you loose the atriums (the upper chambers of the heart) and they don’t fill up with the amount of blood volume like they use to.  You loose a lot of blood volume(RBC’s); what the heart pumps out in the left ventricle to our tissues with oxygen get’s decreased in what we call your cardiac output=the volume of oxygenated blood pumped out of the left ventricle.  Well with atrial fibrillation this gets compensated.  In time if this is not repaired the blood goes backwards in how the heart pumps the blood.  It is regurgitating blood back in the heart back in the pulmonary vein back to the lungs putting fluid in the lungs even going further back into the Rt side of the heart and the superior vena cava and even further depending how long this hasn’t been treated.  Heart failure is set up, if not already.

Heart failure as a result of Atrial Fibrillation with RVR is most common in those who already have another type of heart disease like CAD (Coronary Heart Disease, CHF, etc…).

RVR can cause chest pains and make conditions like congestive heart failure worse.   RVR is simply having a high heart rate with the ventricles only pumping.  The HR can be like 140 or 160.  You need to get to an ER to be treated immediately.  This is where you would be started on a IV drip like Cardizem to bring the HR down to get you in controlled atrial fibrillation or some type of medication in bringing the HR down.  HR meaning the heart rate.

There are 2 types of atrial fibrillations controlled and uncontrolled.  If you are seen every 6 months or sooner with atrial fibrillation keeping your pulse under 100, which is controlled atrial fibrillation that is effective in treating it.

If you are with a pulse over 100 your in Uncontrolled Atrial Fibrillation and need your cardiologist to evaluate what needs to be done to bring the pulse under 100 so that it is less stressful for your heart to beat.  Than would be ideal under 100 as opposed to over 100.  It your over 100 higher odds you could go into RVR or just another rhythm more complicated than atrial fibrillation.  The more stressed out your heart is in doing its function the higher the odds your heart will go into problems.  So keep the pulse under 100 if you have afib and if not get checked out by your cardiologist or any doctor now not 2 mths or 2 weeks from now.

Always check with your doctor when you question anything medical about your self but at any time if you feel chest pain, chest discomfort, headache, palpatations, dizziness, shortness of breath or difficulty breathing call your doctor and be resting in hopes that the symptoms decrease to disappear.

If you have chronic atrial fibrillation you can live a completely normal life only with keeping the pulse under 100 and following up with your cardiologist as he/she orders.


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