The majority of patients diagnosed with AF will be reasonably well and suitable to be managed within primary care, however some patients will present acutely unwell with AF – these patients will have a heart rate greater than 160bpm and may be hypotensive. Their symptoms will be new onset (less than 48hrs) and they will experience some or all of the following symptoms:
- Breathless
- Palpitations
- Dizziness or syncope
- Signs of acute heart failure
- Chest pain
- Fatigue
These patients should be admitted acutely to hospital.
Assessment of Hamish:
- Oxygen saturations: to assess blood oxygen levles to determine whether oxygen therapy is required.
- Cannula: Acute admission with AF requires intravenous access to allow drugs to be given with blood tests, often taken at time of drugs given. Blood tests are often taken. Subcutaneous low molecular weight heparin or intravenous heparin should be started pending treatment with an oral anticoagulant in patients with a high stroke risk.
- Blood pressure: to obtain a baseline blood pressure. High or low blood pressure may require urgent treatment.
- 12 lead ECG: to assess rhythm and rate. If heart rate greater than 120bpm and/or symptomativ, consider acute rate control.
- Chest x-ray: to look for posssible causes of AF and possible signs of heart failure.
- Cardiac monitoring: to assess heart rate and rhythm and monitor for signs of potential life threatening arrythmias.
- Rhythm control: this can be either pharmacological or electrical cardioversion or rate control. This can be using oral or intravenous (IV) drugs to slow heart rate to less than 110bpm
Page last reviewed: 29 Jul 2020
