Fibrillating Fay — Atrial Fibrillation
Irregularly irregular — rate, rhythm, and clot prevention
Fay's heartbeat has no pattern at all. Blood swirls in a corner of her atrium that never fully empties, and in that stillness a clot begins to build.
Fay's atria quiver instead of contracting. No P waves, irregularly irregular rhythm, and blood pooling in the atrium that forms clots. Control the rate, consider rhythm conversion, and anticoagulate — stroke prevention is the whole point.
Read Fibrillating Fay's full story →The story arc
The setup
Long-standing hypertension stretches her left atrium until the electrical signals lose their order.
The turn
She feels a flutter in her chest, gets winded climbing stairs, and her pulse is irregularly irregular with a deficit between apical and radial counts.
The crisis
Rate 148 with hypotension and dizziness — and she has been off anticoagulation for three weeks.
The save
Rate control with diltiazem, transesophageal echo to exclude atrial thrombus before cardioversion, then long-term anticoagulation.
NCLEX study section — Atrial Fibrillation
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Cardiovascular
Take this chapter into practice questions on the same topic.