Question:medium
Which one of the following is NOT the feature of Atrial fibrillation?
Which one of the following is NOT the feature of Atrial fibrillation?
Show Hint
The 'a' wave on JVP needs an organised atrial contraction, which atrial fibrillation does not have.
Updated On: Jul 7, 2026
- Varying intensity of First Heart sound
- Pulse deficit
- Disappearance of Presystolic accentuation of mid diastolic murmur
- Prominent 'a' wave on JVP
Show Solution
The Correct Option is D
Solution and Explanation
Step 1: Fix the core problem in atrial fibrillation.
The defining problem in this rhythm is that the atria lose their single coordinated contraction and instead quiver chaotically. Every clinical sign that depends on a clean, timed atrial push should therefore disappear, while signs caused by irregular ventricular filling should appear.
Step 2: Confirm the three genuine features.
Varying first heart sound intensity comes from the changing gap between beats, which changes how far the mitral valve leaflets have drifted apart before they slam shut, so its loudness varies. Pulse deficit comes from weak, rapidly following beats that do not push enough blood to be felt at the wrist even though the heart sound is heard at the chest. Loss of presystolic accentuation in a mid diastolic murmur happens because that accentuation was created by the atrial kick, and atrial fibrillation removes that kick. All three follow directly from the loss of organised atrial activity.
Step 3: Test the fourth statement against the same logic.
A prominent 'a' wave needs the opposite of what atrial fibrillation causes, it needs a strong, coordinated atrial contraction pressing against a stiff or obstructed right ventricle. Since atrial fibrillation destroys coordinated atrial contraction, the 'a' wave cannot be prominent, in fact it is absent in this rhythm.
Step 4: Conclude.
The option describing a prominent 'a' wave is the one that goes against how atrial fibrillation actually behaves, so it is the correct answer to "NOT a feature."
The defining problem in this rhythm is that the atria lose their single coordinated contraction and instead quiver chaotically. Every clinical sign that depends on a clean, timed atrial push should therefore disappear, while signs caused by irregular ventricular filling should appear.
Step 2: Confirm the three genuine features.
Varying first heart sound intensity comes from the changing gap between beats, which changes how far the mitral valve leaflets have drifted apart before they slam shut, so its loudness varies. Pulse deficit comes from weak, rapidly following beats that do not push enough blood to be felt at the wrist even though the heart sound is heard at the chest. Loss of presystolic accentuation in a mid diastolic murmur happens because that accentuation was created by the atrial kick, and atrial fibrillation removes that kick. All three follow directly from the loss of organised atrial activity.
Step 3: Test the fourth statement against the same logic.
A prominent 'a' wave needs the opposite of what atrial fibrillation causes, it needs a strong, coordinated atrial contraction pressing against a stiff or obstructed right ventricle. Since atrial fibrillation destroys coordinated atrial contraction, the 'a' wave cannot be prominent, in fact it is absent in this rhythm.
Step 4: Conclude.
The option describing a prominent 'a' wave is the one that goes against how atrial fibrillation actually behaves, so it is the correct answer to "NOT a feature."
Was this answer helpful?
0
