冠脉搭桥术后房颤的治疗（英文版）课件.ppt

The Management of Atrial Fibrillationafter Coronary Artery Bypass Graft Surgery KellyAnn Prime RN Bsc Hons Objectives List demographics of coronary heart disease List incidence of atrial fibrillation Identification of atrial fibrillation Discuss causes of atrial fibrillation Discuss treatment options Apply theory to practice Content Demographics National Service framework Atrial fibrillation and CABG What is atrial fibrillation Causes of atrial fibrillation Symptoms of atrial fibrillation Diagnosis of atrial fibrillation Management of atrial fibrillation Complications of atrial fibrillation Q & A Demographics Cardiovascular disease - 216,000 deaths in 2004 Coronary heart disease – 105,000 deaths in 2004 CHD 32% of premature deaths in men , 24% in women (BHF 2005) National Service Frameworkfor CHD To reduce deaths in < 75yrs by 40%= 83.8 deaths per 100,000 by 2010 (DOH 1999) Implementing standards of care using clinical and cost effective measures. Atrial fibrillation and CABG >30,000 CABGS per year (BHF 2006) One side effect of CABG – atrial fibrillation 1 in 20 people > 65yrs (Hubbard 2004) 20 – 40% of patients who undergo CABG will experience AF Peri- operative AF- severe left ventricular dysfunction Atrial Fibrillation - Normal pathway disrupted by extra impulses stimulating the atria – loss of synchrony - extra stimuli originates outside one or more of the pulmonary veins – abnormal atrial tissue – maintains arrhythmia upper chambers of atria “fibrillate” – ventricular rate fast and erratic (Hubbard 2004) Roaming re- entry circuits diffusing around areas of fixed or functional conduction blocks (Archibold and Schilling 2004) Paroxysmal vs spontaneous Acute onset vs persistent Diagnosis of AF ECG – lack of p waves Low BP – decreased cardiac output- body compensation Ventricular rate 120-200 bpm Causes of atrial fibrillation CHD and MI Hypertension Valvular Heart disease (mitral stenosis) Thyrotoxicosis Pericarditis Myocarditis Hea