AF Atrial fibrillation

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AF Atrial fibrillation

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AAAAA
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02/19/07 - 05:39 PM

A 70-year-old woman is evaluated because of dyspnea and effort intolerance over the last 6 months. She has a history of hypertension that is well controlled with hydrochlorothiazide. Physical examination and electrocardiographic findings are consistent with atrial fibrillation, with a ventricular rate of 100/min, but are otherwise normal. Echocardiogram shows a left ventricular ejection fraction of 55%, with left atrial enlargement, mitral annular calcification, and mitral regurgitation. She has no history of stroke or ulcer disease.

Which of the following would be the most appropriate therapy for this patient?

( A ) Aspirin and amiodarone
( B ) Aspirin and a β-blocker
( C ) Aspirin and digoxin
( D ) Warfarin and a β-blocker

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amirhossein
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02/19/07 - 07:29 PM

I would go with d.

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yu
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02/19/07 - 08:46 PM

sarika
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02/19/07 - 09:17 PM

she has mitral reg we cant use Beta blocker that will increase her preload. I will choose aspirin and amiadrone. no need for digoxin either as EF is 55%

amirhossein
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02/19/07 - 10:19 PM

6 months a-fib defenitely needs warfarin.

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AAAAA
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03/05/07 - 01:56 PM

sarika wrote:
she has mitral reg we cant use Beta blocker that will increase her preload. I will choose aspirin and amiadrone. no need for digoxin either as EF is 55%

amidorone is reserved for cardiologist to use in "many" cases in hospitals.

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AAAAA
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03/05/07 - 01:56 PM

( D ) Warfarin and a β-blocker is the correct answer

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AAAAA
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03/05/07 - 02:01 PM

sarika wrote:
she has mitral reg we cant use Beta blocker that will increase her preload. I will choose aspirin and amiadrone. no need for digoxin either as EF is 55%

Amiodarone has been widely used for prevention of sustained ventricular arrhythmias and atrial Fibrillation, particularly in patients with coronary artery disease. However, this drug does not have proven efficacy for preventing sudden death in high-risk patients with hypertrophic cardiomyopathy. In addition, long-term use of amiodarone is associated with potentially serious adverse side effects

(pulmonary fibrosis, thyroid

toxicity) making its use

problematic in kind of

patients.

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AAAAA
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03/05/07 - 02:04 PM

sarika wrote:
she has mitral reg we cant use Beta blocker that will increase her preload. I will choose aspirin and amiadrone. no need for digoxin either as EF is 55%

Researchers presented two reports on the use of beta-blockers in patients with chronic severe mitral regurgitation, or MR, and congestive heart failure, CHF, at the American College of Cardiology's 54th Annual Scientific Session on March 7. These patients had a normal ejection fraction, a measure of how well the heart pumps out blood.

beta blockers can be used even in severe MR !!

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AAAAA
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03/05/07 - 02:05 PM

#10

amirhossein wrote:
6 months a-fib defenitely needs warfarin.

6 months ????

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