Atrial fibrillation
Sudden Arm Pain
A 74-year-old woman develops sudden right arm pain while writing, without trauma. Her hand is cold and distal pulses are absent.
Look for
- Irregularly irregular R–R intervals.
- No repetitive organized P waves.
Where to look. Compare R–R intervals within each lead; look for atrial activity in II and V1. This figure does not include a long rhythm strip.
Disorganized atrial activity reaches the ventricles variably, producing irregular R–R intervals. AF can promote an atrial thrombus and embolism; an ECG alone does not prove a clot.
The source attributes the arm ischemia to cardioembolism; AF is a relevant clue rather than an image of the thrombus.
References & provenance
The ECG Made Easy, 9e, ch. 4, PDF 113–114; Lilly, 6e, ch. 12, p. 296–297.
Acute Upper Extremity Ischemia Due to Cardioembolism From Undiagnosed Atrial Fibrillation
Shin T Zaw; Thinzar Zaw; Edwin C Pigman. Acute Upper Extremity Ischemia Due to Cardioembolism From Undiagnosed Atrial Fibrillation. 2022. doi:10.7759/cureus.21148. Figure 1. CC BY 4.0. CC BY 4.0
Adaptation: cropping and removal of headers/annotations outside the tracing where applicable; metadata removed. Waveforms have not been redrawn.
Compared with the published source; no independent clinical validation is claimed.
Original annotations & limitations
FA dans un contexte d’ischémie artérielle aiguë
Femme de 74 ans; douleur aiguë atraumatique du bras droit en écrivant; main froide et pouls distaux absents; FA à 93/min et occlusion artérielle documentées.
Ne pas transformer les hypothèses étiologiques en certitudes; formulation: source cardioembolique retenue par les auteurs.