can you feel it?
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Overview of the session Atrial Fibrillation Early signs and symptoms of stroke and
TIA Theory of taking a pulse Practical session on taking pulses Recording findings when to refer
Learning Outcomes
Define Atrial Fibrillation (AF) Understand the causes of AF List some of the common symptoms Recognise the complications associated with
AF
Can You Feel it? Atrial Fibrillation is the most common heart
rhythm disturbance and affects up to 500,000 people in the UK
AF can affect adults of any age and becomes more common the older you get
In the over 75–year- old age group it affects about 10% of people
It accounts directly for over 96,000 hospital admissions per year
It consumes 1% of the NHS total budget Left untreated AF can lead to serious
complications such as heart failure and stroke
The Heart The heart is a muscular organ that generally situated
in the middle of the chest, slightly towards the left Structurally, the heart consists of two sides, a right
and left The right side pumps the blood through the lungs to
collect oxygen before travelling to the left side of the heart
From here it is pumped through the body. To return eventually to the right side once more
Both sides of the heart contract at the same time in a single coordinated action to produce a heart beat
What happens in AF? When the heart beats normally, its muscular
walls contract (tighten and squeeze) to force blood out and around the body. Then they relax, so that the heart can fill with blood again. This process is completed every time the heart beats
In AF, the upper chambers of the heart (the atria) contract randomly and sometimes so fast that the heart muscle cannot relax properly between contractions
What causes AF? High blood pressure Coronary heart disease Mitral valve disease (caused by rheumatic
heart disease, valve problems at birth, or infection)
Congenital heart disease (abnormality of the heart present since birth)
Pneumonia Lung cancer Pulmonary embolism Overactive thyroid
Symptoms of AF Palpitation Tiredness Shortness of breath Dizziness Chest pain (angina) Low blood pressure Heart failure Some AF patients have no symptoms at all and it
is only discovered at a routine medical examination
Complications of AF When the atria (upper chambers of the heart) are
not pumping efficiently, as in AF, there is a risk of blood clots forming
The blood clots may move into the ventricles (lower chambers of the heart) and get pumped into the lungs or the general blood circulation
Clots in the general circulation can block arteries in the brain, causing a stroke
The risk of stroke in people with AF is about double that of the general population
Complications of AF However the risk depends on a number of
factors, including: Your age Whether you have high BP Heart failure Diabetes Previous history of embolism
Learning Outcomes Define what a Stroke and TIA is Understand the causes of a stroke/TIA Recognise the signs and symptoms of a
Stroke/TIA Understand why recognition of the onset of
signs and symptoms is essential Justify the need to access emergency/urgent
services for prompt assessment. Understand F.A.S.T
Stroke/TIA causes and risk factors High blood pressure Cardiovascular
disease Diabetes Age Gender Ethnic background Genetic inheritance
Smoking Unhealthy diet Lack of exercise Alcohol
What is a Stroke/TIA? A stroke is an attack on the brain. It happens when the blood supply to part of
your brain is cut off. For the brain to function, it needs a constant
blood supply. Which supplies vital nutrients and oxygen. A stroke happens when the blood supply to
part of the brain is cut off. The brain cells die or are damaged.
Types of Stroke There are two main types of stroke. The most common type of stroke (about 80% of
cases) is caused by a blockage. This is called an Ischaemic stroke and may be caused by:
cerebral thrombosis - when a blood clot (thrombus) forms in a main artery to the brain.
cerebral embolism - when a blockage forms in a blood vessel somewhere else in the body . Caused by a blood clot, air bubble or fat globule (embolism) and is carried in the bloodstream to the brain.
Types of Stroke The second type of stroke is caused by a bleed (in
about 20% of cases). This is called a Haemorrhagic stroke and happens
when a blood vessel bursts, causing bleeding (haemorrhage) in the brain. May be caused by:
1. intracerebral haemorrhage, when a blood vessel bursts within the brain.
2. subarachnoid haemorrhage, when a blood vessel on the surface of the brain bleeds into the area between the brain and the skull (subarachnoid space).
Transient ischaemic attack (TIA) A Transient Ischaemic Attack (TIA) happens when
your brain’s blood supply is interrupted for a very brief time. This is often called a mini-stroke.
It is an episode where some brain function is temporary lost due to a short lived disruption in the blood supply to the brain.
With a TIA, part of your brain goes without oxygen for just a few minutes.
A TIA is a sign that this part of your brain is not getting enough blood and that you may be at risk of a more serious stroke in the future.
What are the common symptoms of stroke?
Sudden, severe headache Numbness, weakness or paralysis on one
side of your body (signs of this may be a drooping arm, leg or lower eyelid, or a dribbling mouth)
Slurred speech or difficulty finding words or understanding speech
Sudden blurred vision or loss of sight Confusion or unsteadiness
The opportunistic detection of Atrial Fibrillation (AF) to prevent the risk of stroke and other serious medicalconditions associated with the presence of AF
Learning Outcomes Understand how to detect a pulse Identify /describe a regular pulse Identify/ describe an irregular pulse Demonstrate manual palpation of a radial
pulse Explain how to document your residents
pulse readings Identify what action to take when an irregular
pulse is detected Record outcome of action taken
What is your pulse? When the heart beats blood is pushed out of
the heart into the body causing a bulge in the arteries. This bulge of pressure is called a pulse, and the pulse can be felt anywhere an artery passes close to the skin.
The pulse indicates the heart rate and the heart rhythm. Being aware of your pulse is important because it may indicate an abnormal heart rate or rhythm. The pulse can be taken in several points on your body. Can you name two of the easiest places?
On the neck: below the earlobebetween the muscle of the neckand the wind pipe (carotid pulse)
On the wrist: between the endof the thumb and where a watchstrap would rest (radial pulse)
Regular/Irregular Pulse The pulse should be regular, i.e. the bulges
caused by the heart beating occur with the same rhythmical timing.
Irregular pulse when palpated will not have the rhythmical timing of the regular pulse and therefore should be palpated for longer.
Bom – bom – bom – bom – bom – RegularBom – bom – bombom – bom –bombom - Irregular
Why it is important? An irregular pulse strongly indicates that the
heart is not beating in a uniformed way and moving the blood through its chambers swiftly, this can result in the blood flow becoming sluggish and lead to clots which can break loose and travel to the brain or to other parts of the body.
Can you think of things that can affect our pulse rate?
Using three fingers, place them on the inside of the wrist between the watch strap and the base of the thumb.Keep firm pressure on the wrist with your fingers in order to feel the pulse.The rate of the pulse can be found by counting for 60 seconds and multiplying by two, this can give the number of beats per minute The heart rate naturally varies, depending on activity and time of day.Normal pulse rate falls between 60 bpm and 100 bpm.
To assess the resting pulse rate in your wrist, sit down for 5 mins beforehand. Remember that any stimulus taken before the reading will affect the rate. You will need a watch/clock with a second hand.
With your hand, place your index and middle fingers on your wrist at the base of your thumb. Your fingers should sit between the bone on the edge of your wrist and the stringy tendon attached to your thumb. Once you have found your pulse, keep firm pressure on your wrist with your fingers in order to feel your pulse
Tendon
Bone
Pulse
GROUP ACTIVITY
Count for 30 seconds and multiply by 2 to get your heart rate in beats per minute. If your heart rhythm is irregular, you should count for 60 seconds and do not multiply.
Record your findings and follow the pathway.
GROUP ACTIVITY
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