One conundrum often arises with atrial fibrillation and ACS. This is where the CAEP atrial fibrillation checklist starts: aggressively treat secondary causes (eg sepsis, GI bleed, PE, CHF, ACS, alcohol withdrawal), and avoid aggressive rate control in these patients. Clare Atzema has found, patients with atrial fibrillation and an alternate primary diagnosis have three times the mortality rate compared with primary atrial fibrillation. This is important for diagnosis, management and prognosis. Question 2: if it is atrial fibrillation and there is rapid ventricular response, is it fast from a secondary cause? This includes overdiagnosis (applying the label of AF to what is actually sinus dysrhythmia, sinus tachycardia with premature atrial contraction, and/or baseline artifact) and underdiagnosis (applying the label of sinus tachycardia or SVT to what is actually AF, especially flutter). ![]()
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