Atrial Fibrillation: A Case Study

This case study discusses the management of a 68 year old male who presented with chest palpitations secondary to rapid atrial fibrillation. Atrial fibrillation is a common cardiac arrhythmia with serious complications if not treated correctly. This essay will discuss the initial clinical presentation of the patient and examine the management and outcome of the interventions applied. The significance of atrial fibrillation including its pathophysiology and aetiology will also be discussed.

African American male that is seen today for followup post hospital discharge. He is a 48-year-old gentleman with complicated cardiac history as well as neurological history including congestive heart failure. History of strokes 01/2017, possible sick sinus syndrome. He has an implanted pacemaker that was placed in 06/2017, as well as hypertension. He was taken to the Central Hospital on 09/01 with presentation of chest pain, noted to be around his pacemaker site. He identified being in seizure and suddenly felt chest pain with shortness of breath, and was offered nitro, he developed headaches and dyspnea post nitro treatment, of note is that the EKG that was obtained during that process, did not identify any pacemaker spike despite having a

You are the nurse working in an anticoagulation clinic. K.N. is a patient who has a longstanding irregularly irregular heartbeat (atrial fi brillation, or A-fi b) for which he takes the oral anticoagulant warfarin (Coumadin). Recently, K.N. had his mitral heart valve replaced with a mechanical valve. You know that there are different PT/INR (prothrombin time/International Normalized Ratio) goal recommendations based on the indication for anticoagulation. (NOTE: PT has now been replaced by or is reported, in most cases, with INR [International Normalized Ratio], an international value that allows for laboratory standardization. PTT is more properly written

Coumadin (non specific name: warfarin) is an anticoagulant, or blood diminishing drug, that is endorsed to numerous patients who are at danger for creating blood clusters that could bring about heart assaults or strokes. Warfarin is near the most astounding purpose recently and simultaneous investigations of medications that provoke ER visits and occurring an expansion in healing center based offices with the affirmation of patients. Anticoagulation treatment stances perils to patients and over and over prompts unfavorable solution events in light of complex dosing, fundamental ensuing watching, and clashing patient consistence. As a result, various patients who meet current evidence based principles for warfarin treatment are not being managed

Stroke was defined as the sudden onset of a focal neurologic deficit in a location associated with the area of a major cerebral artery. The primary safety outcome was major hemorrhage and was defined as a reduction in the hemoglobin level of at least 20 g/L, transfusion of at least 2 units of blood, or symptomatic bleeding in a critical organ or area. Results were calculated using the Cox proportional-hazards modeling. Systolic embolism or stroke occurred in 199 patients receiving warfarin, 182 patients receiving 110 mg of dabigatran twice daily, and in 134 patients receiving dabigatran 150 mg twice daily. Major bleeding events occurred in 3.36% of participants per year with warfarin, 2.71% per year in patients that received 110 mg of dabigatran, and 3.11% per year in those receiving 150 mg of dabigatran. From calculated data, results revealed that dabigatran administered at a dose of 110 mg twice daily was non-inferior to that of warfarin. Lower rates of stroke were associated with dabigatran administered at a dose of 150 mg twice daily compared with that of warfarin. For safety, it was concluded that the risk of bleeding was lowest with dabigatran 110mg twice daily, and was similar between dabigatran 150 mg twice daily and

There are many people that suffer from venous thromboembolism. Venous thromboembolism includes both deep vein thrombosis and pulmonary embolism. This is the third most common cause of vascular death after a myocardial infarction, also known as a heart attack, and stroke. This article examines the possibility of either full or low intensity anticoagulation therapy versus aspirin. This was a randomized study that consisted of 3,396 individuals who have venous thromboembolism. These individuals either received rivaroxaban, which is an anticoagulant, or 100 mg of aspirin once a day. The individuals in this study completed 6-12 months of anticoagulation therapy and were eligible for inclusion in the study if they were 18 years of age or older. The

Atrial fibrillation (AF) is the most common sustained heart rhythm disturbance in the United States, affecting over 2 million individuals with over 150,000 new cases of AF being diagnosed each year. Approximately 4% of the population over the age of 65 is affected. As a person ages,

Atrial fibrillation is the most frequent cardiac arrhythmia. There has always associated risk of clot formation and embolization that can lead to ischemic stroke. A large number of these ischemic events could be prevented by timely anticoagulation. Warfarin has been used for decades for this purpose, but there are many problems for the patients due to warfarin therapy like there is continuous need of INR monitoring, many food and drug interactions of the drug, late onset of action and risk of major bleeding. Anticoagulation with the Novel oral anticoagulants e.g. Dabigatran, rivaroxaban, apixaban, endoxaban led to similar or even lower rates of ischemic stroke and major bleeding compared to an adjusted dose of warfarin (INR 2-3) in patients

Atrial fibrillation is an important side effect with ivabradine with a recent meta-analysis showing a 15% increase in its incidence with the use of Ivabradine (37). Another combined analysis of SHIFT trial and BEAUTIFUL study reported an increase in atrial fibrillation incidence in this population with a number needed to harm of 58 (38). A proposed mechanism of Ivabradine leading to atrial fibrillation is genetic polymorphisms in HCN4 receptors causing an enhanced effect of ivabradine (39). As mentioned above, HCN4 receptors are found not only in the SA node but also AV node and individuals with genetic polymorphisms of HCN4 can have significant inhibition of the two primary pacemakers tissues of the heart. This provides substrate for atrial tissue to discharge and convert rhythm into atrial fibrillation.

Today millions of Americans live or have lived with Atrial fibrillation. The main concern with this health issue is that many people who lived with it sometimes are not aware of it. Atrial fibrillation is defined by Mayo Clinic (2012) as “an irregular and often rapid heart rate that commonly causes poor blood flow to the body”. It occurs when the four chambers of the heart have a disrupted rhythm. The abnormal functionality of health may lead to a stroke because of the possible blood clot that will be formed. The Atrial fibrillation or Afib put the body in a situation without oxygen and nutrients because the body is not well supplied by a heart that is became weak. In general, only few people will feel change in their heartbeat. They may verbalize

You have made a great observation that, in order for Ana to receive quality health care at this facility, she is in need of a nutritional assessment in how to incorporate the restriction that she is now faced with, in regards to her recent diagnosis of Atrial fibrillation. I would agree, Ana and her brother will need assistance in getting Medicaid approved, as well as, locating any additional programs that she may now qualify for. Thank for sharing.

More than 100 years ago, Mackenzie noted the therapeutic effect of digitalis by slowing the heart rate in atrial fibrillation patients (1). Digoxin was the cornerstone for atrial fibrillation until verapamil was discovered in1967; which shown to be effective in slowing the ventricular rate in atrial fibrillation by Bender, et al..(2). In 1980, Klein and colleagues wrote a letter to the editor to report their experience with verapamil-digoxin interaction that result in increased serum digoxin concentrations (SDC) by 58% (3).

Atrial fibrillation is a common disorder associated with significant morbidity, mortality, and economic costs. Radio-frequency catheter ablation (RFCA) of the distal pulmonary veins and posterior left atrium is increasingly being used by cardiac interventional electrophysiologists to treat patients with atrial fibrillation. The success of RFCA is highly dependent on a preprocedural understanding of the complex three-dimensional (3D) anatomy of the distal pulmonary veins and posterior left atrium. Neither fluoroscopy nor echocardiography can adequately depict this anatomy.

Atrial Fibrillation and its inception are due to innovative health professionals who sought to treat their patients. Dr. Melvin Scheinman performed the first catheter ablation in humans in 1981. Dr. Melvin also utilized high-energy DC shocks to generate scars in his patient’s heart compared to today’s popularized RF energy. Dr Scheinman still remains as an active member of the electrophysiology group at the University of California San Francisco (UCSF). Dr Scheinman’s work has also led to the development of radiofrequency energy catheters. The UCSF radiofrequency energy catheters channel radiofrequency energy to heat the catheter tip and perform much more precise ablation than was possible with DC ablation. Cather ablation has been used for

This stagnant blood forms clots that break off and inter the circulation. Atrial Fibrillation is a factor in about 15% of Embolism stroke.The risk of a stroke from atrial fibrillation can be dramatically reduced with daily use of anticoagulant medication.