1. FUNCTIONAL HUMAN ANATOMY
01:377:213
Betty Kui
Atrial Fibrillation

2. SUMMARY OF THE INJURY
 Atrial fibrillation (AF) is the
most common type of
arrhythmia that occurs
when rapid disorganized
electrical signals cause the
atria to quiver
 This causes a fast and
irregular heart rhythm and
prevents proper blood flow
through heart

3. SUMMARY OF INJURY
 People with AF may not exhibit symptoms
 Severe fibrillation can cause chest pain, increase
risk of stroke, and heart failure if heart rhythm is
very rapid

4. PATIENT PRESENTATION
 78 year old male patient complaining of fatigue,
dizziness, and chest pain during his weekly run.

5. RELEVANT CLINICAL FINDINGS
 The patient exhibits these symptoms periodically in
his recent past two morning jog sessions. Thinking
it was due to dehydration, he drank water after
each episode but found no relief. He says he has
considerable fitness as he enjoys running or
swimming 2 hours every morning. His family has no
history of heart disease but has a history of
hypertension.

6. RELEVANT CLINICAL FINDINGS: PHYSICAL EXAM/
TEST
 Vitals taken upon visit are
 BP: 160/92
 HR: 128 bpm (irregular)
 Respiration rate: 17 bpm
 Lung: Decreased lung sounds
Additional findings:
 Swelling of feet

7. RELEVANT CLINICAL FINDINGS: LAB TESTS
 CBC and Urinalysis
 No abnormalities
 TSH blood test
 TSH and T4 levels are normal ruling out
hyperthyroidism

8. RELEVANT CLINICAL FINDINGS: IMAGING STUDIES
 Electrocardiogram (ECG)
 Results indicate irregular heartbeat
 Echocardiogram
 Results show blood pooling in atria, improper blood flow
 Chest x-ray
 Indication of possible fluid found in lungs

9. CLINICAL PROBLEMS TO CONSIDER
 Based on history, chief complaint, and findings from
examination, other possible diagnosis can be
 Chronic obstructive pulmonary disease (COPD)
 Pulmonary embolism
 Ventricular hypertrophy

10. RELEVANT ANATOMY: HEART
 The heart is the central
part of the circulatory
system. Each heartbeat
pumps blood through the
arteries to the rest of the
body and returns to the
heart via the veins.
 Heart consists of 4
chambers:
 2 upper atria (left and right)
 2 lower ventricles (left and
right)

11. RELEVANT ANATOMY: HEART IN AF PATIENTS
 AF patients’ atria get
bombarded with electrical
signals from the SA node
causing atria to quiver as
these signals are trying to
pass into the ventricles
through the AV node
 AF patients’ ventricles also
beat rapidly but not as rapidly
as their atria

12. RELEVANT ANATOMY: HEART IN AF PATIENTS
 This results in a fast and irregular heart rhythm
 Normal heart rate 60-100bpm
 AF patient heart rate 100-175bpm
 We can identify this difference in the irregularity of heart
relaxations and contractions in an AF patient’s EKG

13. RELEVANT ANATOMY: VALVES OF THE HEART
 2 types:
 Atrioventricular (AV) valves: between atria and
ventricles
 Valves open as ventricles relax (diastole)
 Valves close when blood accumulates and ventricles contract
(systole)
 Semilunar valves: between ventricles and vessels
 Valves open as ventricles contract (systole)
 Valves close as blood volume decreases and ventricles relax
(diastole)
 Abnormal heart valves are a pre-disposing factor for AF

14. RELEVANT ANATOMY: PULMONARY EMBOLISM
 Pulmonary embolism occurs when a clump of
material, usually a blot clot, forms a blockage within
blood vessels in the lungs
 These clots usually originate in deep veins of legs
but can also come from other parts of the body’s
circulation system

15. RELEVANT ANATOMY: PULMONARY EMBOLISM
 2 Types of Blood Circulation:
 Systemic: arteries carry oxygenated blood from heart to
rest of body, veins return deoxygenated blood to heart
 Begins at left ventricle, leaves aorta, and ends at right atrium
 Pulmonary: arteries carry de-oxygenated blood from
heart to lungs, veins return oxygenated blood to heart

16. RELEVANT ANATOMY: PULMONARY EMBOLISM
 Blood flow through the heart and body:
 Right atrium
 Tricuspid valve
 Right ventricle
 Pulmonary semilunar valve
 Pulmonary artery
 Left and right pulmonary arteries
 Lungs
 Left and right pulmonary veins
 Left atrium;
 Bicuspid valve;
 Left ventricle;
 Aortic semilunar valve;
 Aorta
 Arteries
 Capillaries
 Veins
 Superior and inferior vena cava
 Right atrium

17. CLINICAL REASONING: COPD
 Signs and Symptoms
 Shortness of breath
 Chest tightness
 Chronic cough producing white/clear/yellow/green
sputum
 Frequent respiratory infections
 Pre-disposing Factors
 Frequent tobacco smoking
 Constant exposure to air pollution/ fumes
 Deficiency of alpha-1 antitrypsin protein

18. CLINICAL REASONING: PULMONARY EMBOLISM
 Signs and Symptoms
 Shortness of breath
 Chest pain
 Cough with bloody sputum
 Leg swelling
 Pre-disposing Factors
 History of cardiovascular disease
 Metastatic cancers like pancreatic, ovarian, or lung
cancer
 Prolonged immobility increasing chance of blot clots
forming

19. CLINICAL REASONING: VENTRICULAR HYPERTROPHY
 Signs and Symptoms
 Shortness of breath
 Chest pain
 Dizziness or fainting
 Sensation of rapid fluttering/pounding heartbeats
(palpitations)
 Pre-disposing Factors
 Frequent smoker
 Overweight
 Have a condition that increases risk of hypertension
 Ex. Hypertrophic cardiomyopathy, a genetic condition in which
the heart muscle is abnormally thick making it harder to pump
blood

20. REFERENCES
 Holland K. Atrial Fibrillation Blood Clots: Symptoms,
Prevention, and More. Healthline. 2016.
http://www.healthline.com/health/atrial-fibrillation-blood-clots.
Accessed February 20, 2016.
 Rosenthal L. Atrial Fibrillation Workup: Approach
Considerations, Electrocardiography, Lab Studies.
Emedicinemedscapecom. 2016.
http://emedicine.medscape.com/article/151066-workup.
Accessed February 19, 2016.
 Sinha S. Clinical Case: New-Onset Atrial Fibrillation.MedPage
Today. 2016. http://www.medpagetoday.com/resource-
center/managing-afib/new_onset_clinical_case/a/35443.
Accessed February 20, 2016.
 What Is Atrial Fibrillation? - NHLBI, NIH. 2016.
https://www.nhlbi.nih.gov/health/health-topics/topics/af.
Accessed February 20, 2016.