AAAAA
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A 78 year old male was referred to your office from
ER. He was found to have dyspnea and presented to
the ER over the weekend and found to have atrial
fibrillation with ventricular rate 128/min.
In your office, he has a "NORMAL EKG" with rate 78
beats per minutes, normal sinus rhythm. P.E. is
normal. B/P is 128/76, no history of chest pain and
he feels fine in your office.
What do you do next ?
1. Observation
2. Echocardiogram
3. Anticoagulation
4. Long-term antiarrhythmic drug therapy i.e.
amiodarone
5. Prepare for rhythm-control cardioversion after 3
weeks of anti-coagulation
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| AAAAA
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Posts: 1,991
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Question 2
If the patient presents with persistent atrial fibrillation
at your office with rate of 150/min. What is your next
management ?
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| AAAAA
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Posts: 1,991
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Question 3.
If the patient in Question 2 was found to have an
atrial thrombus on tranesopheal echocardiogram.
What is your next management ?
________________________________
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| AAAAA
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Any answers ?
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| achilles
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Posts: 1,216
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1st question- echocardiography
2nd-verapamil ?
3rd-anticoagulation
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| cyra
Moderator
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Posts: 844
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Q 1.Echocardiogram
Q2. Check if the patient is hemodynamicaly stable or not?If stable take measures to control the ventricular rate with adenosine or drugs such as verapamil,diltiazem or Metoprolol.Once the vent rate is lowered to <100 bpm conversion to normal sinus rythm should be attempted with durgs like propofenone or amiodarone....if this doesn't work an elective electrical cardioversion should be planned.If the patient is hemodynamically unstable ----> immediate cardioversion.I realise I have harped on about "emergency" management of atrial fibrillation...my question is...would all this apply to an office setting?I am sure AAAA will be able to enlighten us on this..
Q3. Anticoagulation
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| Rasul
Forum Guru
Topics: 56
Posts: 485
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1. anticoagulation
2. digoxin-I assume it's the same pt as in q 1, and he's hemodynamically stable
3.anticoagulation
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| msyamp
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Posts: 1,462
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I agree with CYRA
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| AAAAA
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Dr. Cyra,
I love to make my contribution here.
I understand the hardship ALL IMG go through.
In real life, you use amiodarone and warfarin for attempted chemical rhythm ONLY the patient is proven has no atrial thrombsis and also anticoagulated first.
I know the textbook alos mentioned propofenone but I have not seen any Cardiologists use this drug much.
Amiodarone and warfarin are the drugs of choice for attempted chemical cardioversion !
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