1. This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student under Nephrology Division under the supervision and administration of Prof. Jamal Al Wakeel, Head of Nephrology Unit, Department of Medicine and Dr. Abdulkareem Al Suwaida, Chairman of Department of Medicine and Nephrology Consultant. Nephrology Division is not responsible for the content of the presentation for it is intended for learning and /or education purpose only.

2. Presented By: MOSA MUBARAKY Medical Student

3. 1-CLASSIFICATION 2-ETIOLOGIES 3-PATHOPHYSIOLOGY 4-MANEGMENT

4. -1 ST DECTED VS. RECURRENT -PAROXYSMAL VS. PERSISTENT VS. PERMENANT -VALVULAR VS. NON VALVULA -LONE AF

5. 1-ACUTE(UP TO 50% W/O IDENTIFIABLE CAUSE) -CARDIAC -PULMONARY -METABOLIC -DRUGS

6. 2-CHRONIC -INCREASED AGE -HTN -ISCHEMIA,VAVLE DIS. -HYPERTHYRIODISM -OBESITY

7. -COMMONLY ORIGINATES FROM ECTOPIC FOCI -LOSS OF ATRIAL CONTRACTION >HF,LA STASIS>THROMBOEMBOLI

8. - Atrial fibrillation occurs when many sites in the atria rapidly fire action potentials. The result is a VERY fast atrial rate (about 400-600 beats per minute). Since the atrial rate is so fast and the action potentials produced are of such low amplitude, P waves will NOT be seen on the EKG in people with atrial fibrillation.

9. NO P WAVE

11. -H,P,ECG,CXR,ECHO

13. Calcium channel blockers -Diltiazem (Cardizem) 15 to 20 mg IV over 2 minutes; may repeat in 15 minutes 5 to 15 mg per hour by continuous IV infusion Convenient; easy to titrate to heart rate goal - -Verapamil (Calan, Isoptin) 5 to 10 mg IV over 2 minutes; may repeat in 30 minutes Not standardized More myocardial depression and hypotension than with diltiazem

14. Beta blockers -Esmolol (Brevibloc) Bolus of 500 mcg per kg IV over 1 minute; may repeat in 5 minutes 50 to 300 mcg per kg per minute by continuous IV infusion Very short- acting; easy to titrate to heart rate goal -Propranolol (Inderal) 1 mg IV over 2 minutes; may repeat every 5 minutes to maximum of 5 mg 1 to 3 mg IV every 4 hours Short duration of action; hence, need for repeat dosing

15. -Digoxin (Lanoxin) 0.25 to 0.5 mg IV; then 0.25 mg IV every 4 to 6 hours to maximum of 1 mg 0.125 to 0.25 mg per day IV or orally Adjunctive therapy; less effective for rate control than beta blockers or calcium channel blockers