A irregularly irregular rhythm varying from bradyarrhythmia to tachyarrhythmia. Etiologies include ischemia, atrialdilation, surgery, pulmonary disease, thyrotoxicity, alcohol intoxication. Symptoms: palpitation, fatigue, dizziness,hypotension, syncope, tachycardia. Cardiac auscultation revealing irregularly irregular rhythm.

Etiology

* Coronary artery disease

*MS, MR, AS, AR

* Thyrotoxicosis

* Pulmonary embolism, COPD

* Pericarditis

* Myocarditis, cardiomyopathy

* Tachycardia-bradycardia syndrome

* Alcohol abuse

*Ml

* WPW syndrome

* Other causes: left atrial myxoma, atrial septal defect, carbon monoxide poisoning, pheochromocytoma, idiopathic

Workup

New-onset atrial fibrillation: ECG echocardiogram Holter monitor, and laboratory evaluation.

Note irregular fibrillatory waves (f).

Treatment

* Vagal maneuver or ice water immersion, or carotid massage (avoid it doing billateraly and in patients with catorid

bruits)

* If vagal maneuvers fail, do rapid IV infusions of adenosine, or calcium channel blockers (do not use verapamil in