In a physical exam, Rachel B\'s heart rate was rapid and very irregular. Further

Question

In a physical exam, Rachel B's heart rate was rapid and very irregular. Furthermore, her heart rate as determined by listening to her heart with a stethoscope, exceeded the pulse rate taken concurrently at her wrist. No definite P waves could be detected on Rachel's ECG. The QRS complexes were normal in shape but occurred sporadically. What is the most likely diagnosis of Rachel's condition? Explain why the condition is characterized by a rapid, irregular heartbeat. Would cardiac output be seriously impaired by this condition? Why or why not? What accounts for the pulse deficit?

Explanation / Answer

The most likely diagnosis which correlates with all the signs and symptoms is atrial fibrillation. In this disorder, atria is beating at a rate of approximately 500 beats per minute some of which are also passed to ventricle after being reduced by AV node. This is why there is rapid and irregular heart beat. The atria and ventricle contraction are not much powerful, this would affect the cardiac output severely. Cause of pulse deficit is that ventricular systole is powerful enough to close mittal valve to produce heart sound but not enough to open aortic valve to pass blood which would show peripherally as pulse.

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