Question

A Fib Case Study A 67-year-old man presents to the ER with palpitations and dyspnea which began approximately 4 hours ago. He has a history of HTN, left ventricular hypertrophy, Diabetes, and GERD. His current medications are lisinopril, metformin, and omeprazole. He has no history of stroke or TIA. He is accompanied by his wife who reports drinking 1 pot of coffee daily and 1-2 beers on the week-ends. He does not binge drink or use herbal or alternative mediations. His wife reports he snores and has daytime sleepiness. He quit smoking 10 years ago. He appears to be in mild respiratory distress. Blood pressure is 88/60mmHg, pulse rate is 140 bpm, respiratory rate is 24/min, and temperature is normal. Oxygen saturation is 90% on 40% oxygen by face mask. His BMI is 36. Cardiac exam reveals tachycardia with an irregularly irregular tachycardic rhythm. There are crackles in the lower lung fields. A chest radiograph does not show infiltrates, pleural effusions, masses, blebs, or hyperinflation. Laboratory analysis reveals normal thyroid function, D-dimer and cardiac biomarkers. Electrocardiogram demonstrates atrial fibrillation (AF) with rapid ventricular rate. This patient is determined to need acute management of AF with hemodynamic instability.

Questions:

1. As the nurse caring for this patient, the family asks you what will be the primary treatment modality. Provide an explanation of what you would tell the family. Be specific on what is involved in the procedure.

Answer 1

Atrial Fibrillation

Atrial Fibrillation refers to a condition characterised by the presence of Cardiac arrhythmia( abnormal heart rhythm) that involves the two upper chambers( atria) of heart.

Hemodynamic instability

It is a condition characterised by the impaired perfusion( blood supply) to the tissues and the presence of hypotension and shock. In this case study the patient' s Blood pressure is 88/60 mm of Hg.

Primary treatment modality

Primary treatment modality for Atrial Fibrillation with hemodynamic instability is the medical procedures of Cardioversion and Cardiac catheter ablation.

Cardioversion( electric shock) : It is treatment with the use of an equipment( cardioverter) that supplies a controlled electric current to restore the heart from arrhythmias. The electrical shock will cease the electrical activity of the heart for a short duration. Electro cardioversion is done in the presence of sedation.

Drugs used for Cardioversion are ;

Warfarin( anti coagulant) to prevent blood clots

Beta blockers are contraindicated due the presence of hypotension.

Amiodarne, propafenone for maintaining the heart rhythm.

Cardiac ablation can be performed if the heart is not responding to Cardioversion and anti arrhythmic drugs.(Catheter Ablation: Through cardiac catheterization( inserting thin tubes through a large blood vessel in neck or groin to heart) destroying the cardiac tissue, that causes arrhythmia, with the use of radiofrequency or cold.)