Atrial fibrillation with fast ventricular rate

[syedz]

What is the definition of acute Atrial fibrillation? Is it related to duration or symptoms?
How the atrial fibrillation with fast ventricular rate should be treated in hemodynamically stable patients? What are the choices available?
How the patient with acute ischemic stroke & atrial fibrillation with fast ventricular rate should be treated? Will the medicines controlling the heart rate not lower down the blood pressure, resulting in worsening of stroke? In these subset of patients(acute ischemic stroke & atrial fibrillation), what is the role of anticoagulation?

[BLM_56]

Acute means generally something of a short duration where chronic means a long duration.  When my a-fib lasted more than a couple of weeks and cardioversion failed to knock me into normal sinus, they started characterizing it as chronic.  In my case it is not only chronic but irreversable.  My atria will almost certainly still be quivering when my heart stops for good.

If the a-fiib is causing the ventricles to beat irregularly or too fast then it is possible for the ventricles to go into fib - and THAT will kill you because when your venricles are fibrillating your heart is no longer pumping.  Like Jerry I have seen nothing in all my reading to indicate that the medications used for rate control - i.e. keeping the ventricles slow enough to keep them from going into fib - have any sort of effect on ischemic stroke.  When your heart throws a clot and that clot enters the carotid the only place it can go is to the brain where it will travel down increasingly smaller arterial branches until it hits a spot too small to let it pass.  At that point blood stops flowing down that branch and everything down stream of that point stops getting blood.  As I understand the mechanism of ischemic stroke blood pressure has nothing to do with severity.  It is essentially solely determined by the size of the clot.  The bigger the clot, the larger the diameter of the arterial branch that it needs to continue to travel and the larger the volume of tissue affected by the interruption of blood supply.  

Anti-coagulants are given to keep further clots from forming.  Unfortunately, they do nothing about clots that may have already formed but are still lurking in the fibrillating atria.  There are medications that can dissolve clots.  Coumadin/warfarin only reduces the likelyhood of clots forming in the first place.  Unfortunately, not everyone is "instrumented" such that they can percieve themselves being in a-fib.  I used to be able to feel even occasional PACs but was in full blown a-fib last October and didn't know it.  If someone were in a-fib without knowing it, then the first sign of problems could easily be a stroke.  The only reason I found out about my a-fib going chronic was that my cardiologist likes to have me come in every so often just to touch base and see how the meds are working.  BTW, when I found out I was in (what turned out to be permanent) a-fib it was less than 4 months since my dad had died from a series of ischemic strokes that resulted from him not monitoring his coumadin levels.  

Rate control in the case of chronic a-fib is, as I mentioned earlier, to reduce the liklihood of ventricular fib.  Stroke CAN kill.  V-fib without prompt treatment WILL kill.  Within 45 seconds after you go into v-fib - i.e. your heart stops pumping - you WILL lose consciousness.  Within 3 minutes of onset of v-fib without treatment (CPR or cardioversion) your brain starts to die.  Stroke CAN kill but absent VERY PROMPT treatment v-fib WILL INVARIABLY KILL YOU.  Hence medication for rate control.  If the rate control medication fails to work properly then they have to do something more drastic and invasive.  The good news is that none of the treatment options after medication increases the liklihood of stroke if the patient is already on anti-coagulants.  The further good news is that you canlive nicely with only your ventricles pumping.

Keep us posted.

Bionic Bill
Cyborg At Large

[Jerry_NJ]

AFig can cause the formation of clots in the artial chamber due to the incomplete pumping action characteristic of AFib. If/when these clots move into the blood stream and if they block oxygen/blood to the brain a stroke occurs.  An Anticoagulant, such as warfarin/coumadin reduce the chance that such clots will form, thus reducing the possibility of a stroke.  

I do not believe the taking of meds to control the heart rate, e.g., Toprol/Metoprolo worsen the possibility of a stroke, or make one, should it occur, worse.  The only symptom I have suffered from by taking Toprol is the noted low blood pressure, which has cause a propensity to dizziness if I rise too fast/suddenly.  It may also reduce my "energy" level.