Ah, atrial fibrillation — the cardiac equivalent of your atria screaming “YOLO!” 😀 and firing impulses like bazooka. If your patient’s ECG suddenly looks like it’s trying to perform jazz hands, don’t panic — just remember the mnemonic: PIRATES 🏴☠️
Because nothing says chaotic atria like a pirate crashing your sinus rhythm.
Triggers of Atrial Fibrillation Mnemonic
| Letter | Trigger | Explanation |
|---|---|---|
| P | Pulmonary Embolism | Sudden strain on the right heart = electrical chaos. 💥 |
| I | Ischaemia | Lack of oxygen makes atria cranky. Classic post-MI arrhythmia. |
| R | Respiratory Disease | COPD, pneumonia… because lungs and hearts love to bicker. 🌬️😤 |
| A | Atrial Enlargement / Myxoma | Big atria = more room for mischief. Tumor bonus: surprise AFib. 🏰 |
| T | Thyroid Disease (esp. hyperthyroidism) | Hyper = heart on espresso. ☕💓 |
| E | Ethanol | Aka “Holiday Heart Syndrome.” Your atria after that third margarita. 🍸💃 |
| S | Sepsis / Sleep Apnoea | Systemic stress or nocturnal suffocation — either way, atria revolt. 😴🔥 |
🔍 Clinical Bonus
- AFib = irregularly irregular rhythm with absent P waves (look above for a classic Afib ECG)
- Always check TSH, electrolytes, and that party animal history (👀 looking at you, E for Ethanol).
If your patient’s heart is behaving like a pirate mutiny — irregular, chaotic, and slightly drunk — remember: PIRATES did it. Blame the booze, the lungs, the thyroid, or just good ol’ atrial rebellion.
HAPPY LEARNING, folks! 🙂
Signing off,
Dr. Aurangzaib Qambrani
(MBBS, PLAB, MRCP-UK 1)
Sheikh Khalifa Bin Zayed Hospital Quetta
