Does paroxysmal atrial fibrillation need anticoagulation?

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The main problems involved above are:

1, what is atrial fibrillation?

2. Causes of atrial fibrillation

3. Symptoms and hazards of atrial fibrillation

4. Classification and treatment of atrial fibrillation

5. Selection of anticoagulant therapy for atrial fibrillation

Let's answer this question:

1, atrial fibrillation is a kind of atrial arrhythmia, that is, atrial electrical activity disorder.

2. At present, hypertension has become an important pathogenic factor of atrial fibrillation, especially poorly controlled hypertension. Old age is also a risk factor for hypertension, and the incidence of atrial fibrillation over 80 years old has reached 10%, or even higher.

There are also many cardiovascular diseases that can lead to atrial fibrillation, such as coronary heart disease and rheumatic valvular heart disease; Hyperthyroidism can also lead to atrial fibrillation; Many patients with lung diseases will also have atrial fibrillation; Normal people can also see atrial fibrillation after emotional excitement, exercise and heavy drinking; There is also atrial fibrillation after fever.

3. Some patients with atrial fibrillation have no symptoms, and their ventricular rate is generally slow; Most people with fast ventricular rate will feel palpitations, some people feel annoyed, and some people feel short of breath. The biggest harm of atrial fibrillation is to affect the heart function, leading to thromboembolism, which can reduce the heart function by about 1/4.

Atrial fibrillation lasting more than 48 hours may cause left atrial appendage thrombosis, and embolus shedding may cause cerebral embolism or arterial embolism of lower limbs. Studies have shown that more than 20% of cerebral infarction is caused by atrial fibrillation embolus falling off.

4. The clinical classification of atrial fibrillation is complicated. We can simply divide atrial fibrillation into paroxysmal atrial fibrillation and persistent atrial fibrillation. As the name implies, paroxysmal atrial fibrillation is "shaking for a while" and then stopping; Persistent atrial fibrillation refers to "persistent" atrial fibrillation.

The treatment of atrial fibrillation is first aimed at the etiology and inducement, followed by anticoagulation and ventricular rate control or cardioversion. The treatment of controlling ventricular rate includes the use of beta blockers, calcium antagonists, digoxin and so on. Cardioversion therapy includes drug cardioversion, electrical cardioversion and catheter ablation. The success rate of cardioversion therapy is very low. Whether to perform cardioversion and which method to choose need to be carefully weighed, and the final decision should be made through consultation with patients.

The incidence of embolism in patients with atrial fibrillation is high, and anticoagulant therapy is an important means. For patients with valvular disease, warfarin should be used for anticoagulation, and INR is up to standard. For patients with non-valvular disease, CHADS2 score can be used for risk stratification, and whether anticoagulation is needed can be determined according to the score.

CHADS2 is the following abbreviation:

The c of congestive heart failure is 1.

Hypertension h is 1.

For people over 75, a is 1.

D diabetes 1 min

S2 has a history of 2-point stroke or transient ischemic attack.

CHADS2 score 0- 1, low risk, 2-3, medium risk, 4-6, high risk. A high score means a high risk of stroke and a low score means a low risk of stroke. Anticoagulation usually begins at ≥2 minutes. Of course, this requires the doctor's judgment. Oral anticoagulants are divided into rivaroxaban, dabigatran and other new anticoagulants. The classic anticoagulant is warfarin. When taking warfarin, it is necessary to monitor the standard internationalization ratio between 2 and 3.

Let's look at the old man again. Nearly 80 years old, hypertension, blood pressure is not well controlled for a long time. Long-term hypertension can not be controlled, and atrial pressure is too high, which leads to atrial fibrosis, thus creating conditions for the occurrence of atrial fibrillation. Carefully ask the elderly who were working in their vegetable fields on the day of atrial fibrillation. The weather is very hot, he feels "heatstroke" and his temperature rises at night.

In this way, the situation of the elderly can be summarized as follows: older age and high blood pressure have laid a good foundation for the occurrence of atrial fibrillation, and fatigue and fever are the inducement. When the body temperature and blood pressure were controlled, atrial fibrillation did not happen again, and then it was normal sinus rhythm. That is to say, this old man's atrial fibrillation is paroxysmal atrial fibrillation, and there are only two atrial fibrillation episodes in the 24-hour dynamic electrocardiogram on that day, and the duration is about 1 hour. Then there is basically no anticoagulation problem.

The elderly then need to continue taking antihypertensive drugs and monitor their blood pressure, while avoiding overwork. If you have another palpitation attack, you need to check your ECG in time to find out if there is atrial fibrillation. Prevention of atrial fibrillation is more important.

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