Question

Abanga was rushed to the hospital on account of fainting, shortness of breath, palpitations and nausea. Abanga was pulseless with unrecordable blood pressure but heart rate of 450bpm. His ECG showed no P-wave nor QRS complex. His Hb was 7.0g/dL(normal range 12.5-16.5g/dL) and MCV was 70fL(normal range 80-100fl). Abanga's drug his indicated that he has been taking antacid(aluminium hydroxide mixture) for the past three months now due to his palpitations and was on prescribed ferrous sulphate which he has been taking for the past one month due to his previous diagnosis of anemia. An impression of arrhythmia and anemia was made by the physician and Abanga was defibrillated with electrical shocks and started on verapamil, warfarin and adrenaline.Laboratory investigation the next day showed high serum potassium levels.

1. what type of arrhythmia and is Abanga likely to be suffering from.

2. Assign reasons to your answers in question.

3. From Abanga's case presented could you guess the cause of his anemia

4. Do you agree with the choice of verapamil, warfarin and adrenaline for Abanga's condition ? Assign reasons.

5. With reasons, what will you suggest to the doctor to improve drug treatment for arrhythmia for Abanga.

Answer 1

1. Atrial fibrillation is the most common chronic arrhythmia, characterized by erratic atrial electrical activity with atrial rates of 400 to 600 beats per minute. The P wave is absent on the surface electrocardiogram and can, at times, be replaced with fibrillatory waves.

2. Because in atrial fibrillation ,there is no p wave and also the QRS complex is irregular.

3. Anemia in patients with atrial fibrillation is associated with major bleeding and lower time in therapeutic range. Patients with atrial fibrillation have higher risk for developing embolism and hence anticoagulant medications are started .

4. Yes ,the drugs are appropriate .

Beta blocker ( adrenaline ) - slows heart rate

Calcium channel blockers ( verapamil ) - also controls the heart rate

Warfarin - to prevent embolism and blood clotting