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Mr. John Jones (61 years) is admitted to the emergency assessment unit at his local hospital complaining of palpitations, breathlessness, and dizziness. He has a 5-day history of some dizziness and palpitations. In the last 24 hours, he complained additionally of shortness of breath. He collapsed at home and was then admitted to the hospital via the emergency department. He experienced similar symptoms two months ago but did not seek medical advice at that time and seemed to recover quickly. On examination and review by the admitting doctor the following information is obtained: Previous medical history Hypertension (diagnosed 5 years ago), no previous history of cardiovascular disease. The patient is a regular cigarette smoker (>20 per day) and drinks approximately 20 units of alcohol per week. Drug history No known allergies. Mr. Jones had been prescribed lisinopril tablets 20 mg once daily but was poorly compliant with treatment. Signs and symptoms on examination ? Blood pressure 100/70 mmHg ? A heart rate of 175 bpm, irregular ? Respiratory rate of 25 breaths per minute ? No basal crackles in the lungs. Diagnosis Atrial fibrillation. Relevant test results Full blood counts, liver function tests, electrolytes and the renal function was all normal at admission and throughout the admission to discharge. Mr. Jones is subsequently transferred to the cardiology ward where his continuing atrial fibrillation is later confirmed as persistent atrial fibrillation. As the ward clinical pharmacist, you are responsible for daily review of drug charts and advice to medical and nursing staff on all aspects of drug treatment for patients on the ward. Questions 1 What is atrial fibrillation? 2 What are the most common signs and symptoms exhibited by patients with atrial fibrillation? Indicate which of these signs and symptoms the patient is exhibiting. 3 What are the two options in terms of a treatment strategy that may be employed to manage atrial fibrillation? Indicate what would be the most appropriate strategy that you could recommend to the doctor managing this patient and why you think this is the case. 4 Assuming a rate control strategy is to be used what class of drug should be the first-line treatment for this patient? If the first-line the drug was contraindicated what class of drug could be used as an alternative treatment? 5 What patient parameters should be monitored to assess therapy with the usual first-line treatment and what is an appropriate treatment target for such parameters? \ 6 What are the two options in terms of antithrombotic prophylaxis in this patient and what are the potential side-effects of each? State which of these is the most appropriate for this patient and why. 7 Assuming the patient is to be discharged on a beta-blocker and aspirin, what counseling does he require?
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1.Atrial fibrillation is an abnormal heart rhythm (arrhythmia) characterized by the rapid and irregular beating of the atrial chambers of the heart it is 100 to 175 beats per minute. It often begins as short periods of abnormal beating, which become longer or continuous over time.
2. Signs and Symptoms of Atrial Fibrillation are-
3.The treatment goals for atrial fibrillation are to:
Firstly the patient is given warfarin or another blood-thinning medication for several weeks to reduce the risk of blood clots and strokes.
For Resetting Heart's Rhythm- Cardioversion is done - It can be Done directly Electrically or by drugs
Although the Maintaince of Cardiac Rhythm is done by-
Other is to Control Rate of Heart-
This can be done by- Cardiac Glycosides ( Digoxin) , Beta-blockers and Calcium-Channel blockers.
The best therapy in this Patient would be first to Control the Rhythm then the Rate.
4. Flecainide, propafenone ( Class Ic) and sotalol ( Class II) to be considered as first line- agents.
If first line agents are Contraindicated then we Consider -Class III Anti-Arrhythmics such as Amiodarone and dofetilide.
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