Rachel Kitchen Atrial Fibrillation - PowerPoint Presentation

Slide1

Rachel Kitchen

Atrial

Fibrillation

Overview

Definition and epidemiology

Symptoms

Tests/Evaluations

Complications

Treatment

Effects on exercise

Medications effect on exercise

Effects of training

Exercise prescription

Definition

Rapid unorganized electrical impulses (not coming from the sinus node-thus not sinus rhythm) cause the atria to squeeze in a rapid and unorganized manner. This is called fibrillation

.

Often referred to as a-fib

Most

common type of

arrhythmia

Affects millions of people

Men are more likely to have than women

Risk increases as you age

Uncommon in children

Definition

Paroxysmal atrial fibrillation

Begins suddenly and stops on its own. Usually stops and starts

whithin

24 hours to a week.

Persistent atrial fibrillation

May start and stop on its own or with treatment. Usually lasts more than a week.

Permanent atrial fibrillation

Atrial fibrillation persists and the normal heart rhythm cannot be brought back with treatment.

Normal Sinus Rhythm vs. Atrial Fibrillation

Doctors involved

Primary care doctor (family practitioners and internists

Cardiologist

Electrophysiologist

(Cardiologist who specializes in arrhythmias)

Signs and Symptoms

Palpitations/Irregular beats/Skipped beats

Shortness of breath

Weakness or problems exercising

Chest pain

Fatigue

Confusion

Risk Factors

High blood pressure

Coronary heart disease (CHD)

Heart failure

Rheumatic heart disease

Mitral valve prolapse

Pericarditis

Congenital heart defects

Sick sinus syndrome

Post heart attack or surgery

Obesity

Diabetes

Drinking large amounts of alcohol

Laboratory Diagnosis

Ambulatory telemetry monitor (ATM) (1-30 day monitoring at home)

Patient presses a symptoms button when having symptoms

If asymptomatic, monitor will catch any abnormalities. If atrial fibrillation is found or other serious arrhythmia the doctor will be notified

This is a newer and very effective way to diagnose and catch atrial fibrillation

Holter

monitor (24 hours monitoring at home)

EKG (10 second strip)

Stress tests

Echocardiography

Transesophageal

Echocariography

(TEE)

Chest X-ray

Blood tests

Tests

Methods

Measures

Endpoints

Comments

Aerobic

Cycle

Treadmill (

ind

. ramp protocol, 8-12 min target.

Moderately incremented protocol<1MET/2-3 min (

naughton/balke

)

*12-lead ECG, HR

*BP

*RPE

*Angina scale

*Gas analysis (VO2 peak)

*Radionuclide *testing

*Serious

dysrhythmias

*>2mm ST-segment

dep/elev

*ischemic threshold

*T- wave inversion with

st

change

*SBP > 250

mmhg

or DBP >115

mmhg

*3+ on angina scale

Better estimate of exercise

capacity

Endurance

6

min walk

Distance walked

Rest stops allowed

Flexibility

Goniometry

Angle of flexion/extension

If lowered ROM

Complications

Two major complications /

Heart failure and stroke

Heart

failure

Heart can’t pump blood sufficiently to the body. The ventricles are pumping really fast to get the blood to the body, but because they don’t completely fill with blood, they may not be able to get enough blood to the lungs and body

Black legs

Fatigue and SOB are common symptoms. Buildup of fluid in the lungs, feet, ankles, and legs causing weight gain. Important to weigh patient. If gaining lots of weight ask if they are retaining fluid

Complications

Stroke

Because atria may not be pumping all the blood out. It can pool and form clots. If the atria pumps a clot through, it can travel to the brain and cause a stoke

Some individuals who are asymptomatic with atrial fibrillation will have a stroke first then be diagnosed late

Atrial fibrillation can cause stroke

http://www.youtube.com/user/boehringeringelheim?v=eb1nLeQiWOM

Treatment: Medical and Surgical

Medicines

Blood clot prevention: Coumadin, heparin, warfarin(84% reduction in stroke risk), and aspirin (aspirin is less effective than warfarin)

Rate control: Beta blockers(

metoprolol

and atenolol) calcium channel blockers(

diltiazem

and verapamil) and digitalis (digoxin)

Rhythm control:

Amiodarone

,

sotalol

,

flecainide

,

propafenone

,

dofetilide

, and

ibutilide

.

Electrical

cardioversion

http://heart.emedtv.com/electrical-cardioversion-video/what-happens-during-electrical-cardioversion-video.html

Treatment: Medical and Surgical

Catheter ablation:

Wire is inserted through a vein in the arm or leg up to the heart. Radio wave energy is sent through to destroy bad tissue that is disrupting the normal electrical flow

Sometime they will destroy the AV node and put in a pacemaker. The pacemaker will help to maintain a normal rhythm

Maze surgery:

Requires open heart surgery. They make small cuts or burns in the atria. This helps to prevent the spread of disorganized or disobedient electrical signals

Effects of Disease on Ability to Exercise

Insufficient scientific literature is available about exercise training and atrial fibrillation

They would not have a significantly different response than a normal sinus rhythm individual. However, the medication they are on will have an influence on exercise

The major concern is underlying problems like heart disease,

valvular

disease, heart failure, and CAD

These underlying conditions should be the most important in considering exercise training

Effects of Medications on Ability to Exercise

Digoxin

May control ventricular response; diffuse ST effects

Calcium channel blockers

May mask ischemia and decrease exercise heart rate response

Diltiazem

, verapamil

Help control ventricular response; may improve exercise capacity

Beta blockers

Help control ventricular response; may reduce exercise capacity. Decrease submaximal and maximal HR and BP response; sometimes exercise capacity, especially with nonselective medications

Things to consider

Age-predicted max HR targets ARE NOT VALID

Irregular ventricular response may make BP values less precise or more difficult to get

Exercise Programming

Modes

Goals

Intensity/Frequency, Duration

Time to goal

Aerobic

*Large

muscles activities

*Arm/leg

ergometry

*Increase VO2 peak

*Increase

ADLs

*RPE 11-16/20

*50-80%

VO2 peak or HR reserve

*3-7 days/week

*30-45 min/session

3 Months

Resistance

Weight machines

Increase strength

*High reps, low resistance

(12-15reps)

*2-3 nonconsecutive days/week

2-3 Months

Flexibility

Upper

and lower body ROM activities

*Increased

felxibility

*Reduce risk of injury

3-5 days/week

2-4 Months

Summary

Atrial fibrillation is most common type of arrhythmia

Can cause stroke or heart failure

Some can be treated for atrial fibrillation others can live with it

Individuals who have atrial fibrillation can exercise, focus on underlying conditions

Medications can have effect on assessment

during exercise

References

ACSM. 2010.

ACSM’s

guidelines for exercise testing and prescription

, 8

th

ed. Baltimore: Lippincott Williams and

Wilkens

, chapter 5.

American Heart Association. 2010.

Cardiovacular

Statistics. http:/.

www.american

heart,org

/

Durstine

, J. L et al., editors. Exercise management for persons with

chronis

diseases and disabilities. Champaign, IL: Chapter 9.

National Heart Lung and Blood Institute. (2001). What is

atrial

fibrillation?

http://nhlbi.nih.gov/health/health-topics/topics/af

/

Youtube

video on atrial fibrillation

and stroke:

http://

www.youtube.com/user/boehringeringelheim?v=eb1nLeQiWOM

Youtube

video on electrical

cardioversion

: http://heart.emedtv.com/electrical-cardioversion-video/what-happens-during-electrical-cardioversion-video.html

Questions