A 63 years old man presents to your OPD with complaints of palpitations and light headedness since 6 hours.
Saad Gillani
CONSULTANT PHYSICIAN ( ACUTE & INTERNAL MEDICINE ) FRCP GLASGOW at ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF GLASGOW
A 63 years old man presents to your OPD with complaints of palpitations and light headedness since 6 hours. According to his attendant, he sometimes gets such episodes and becomes restless and confused during these episodes.
BP is 156/70 mmHG.
You find he has an irregular pulse.
JVP is normal.
No peripheral oedema is present
You perform an ECG which is given below:
1. What are the ECG findings
2. What is the most likely Diagnosis?
3. What are the causes of this condition?
4 . What are the complications of this condition?
5. How would you manage this patient?
Answers given in comments section.
Copyright reserved with the author.
1. What are the ECG findings
Absent p waves , Bizarre f waves.
2. What is the most likely Diagnosis?
Atrial fibrillation with Rapid Ventricular Rate.
3. What are the causes of this condition?
Idiopathic
Hypertension
Old Age
Excessive caffeine
Pericarditis
Myocarditis
Atherosclerosis
4. Complications of Atrial fibrillation:
Blood clots and venous thromboembolism
Stroke
Cardiac arrest
Heart failure
5. Management:
Objectives of management include :
Reset the rhythm or control the rate
Prevent blood clots, which may decrease the risk of a stroke.
Resetting heart's rhythm
Ideally, to treat atrial fibrillation, the heart rate and rhythm are reset to normal.
To achieve this, doctors may be able to reset the heart to its regular rhythm (sinus rhythm) using a procedure called cardioversion, depending on the underlying cause of atrial fibrillation and how long you've had it.
Cardioversion can be done in two ways:
Electrical cardioversion. In this brief procedure, an electrical shock is delivered to heart through paddles or patches placed on chest.
The shock stops heart's electrical activity for a short moment. The goal is to reset heart's normal rhythm.
Cardioversion with drugs.
This form of cardioversion uses medications called anti-arrhythmics to help restore normal sinus rhythm. Intravenous amiodarone is a recognised treatment alternative for the conversion of atrial fibrillation to sinus rhythm. Following a loading dose of 300 mg/30 mins, two alternative dosages of iv maintenance treatment—50 mg/hour and 100 mg/hour are given