Atrial Fibrillation Case Study

2721 Words Aug 5th, 2013 11 Pages
Introduction:
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.

Description of the case:
A 68 year old male presented to the emergency department at 0800 hours via ambulance after experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation, the patient stated he
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Medical involvement included pharmacological intervention. An infusion of Sotalol 40mg was administered intravenously at approx 0930 over thirty minutes with continuous cardiac monitoring. Sotalol, an antiarrhythmic drug, depresses the sinus heart rate, decreases atrioventricular conduction, decreases cardiac output and decreases systolic and diastolic blood pressure (Bryant, Knights, & Salerno, 2003). As the patient was already hemodynamically compromised, a bolus of fluid (Gelofusion 500mls) was administered prior to the Sotalol infusion. The aim was to increase the circulating volume and raise blood pressure. Vital signs remained stable during the infusion, however the heart rate was neither converted to sinus rhythm or reduced to a normal rate.
At 1130 a second antiarrhythmic drug, Amiodarone 150mg, was administered via intravenous infusion. Its action is unknown however is thought to prolong the action potential duration (Siddoway, 2003). Similar to the Sotolol no effect was noted with the rate or rhythm. The patients blood pressure remained low, 96/67 and heart rate fluctuating between 100-130 beats per minute. The patient was asymptomatic with his blood pressure but remained sweaty and lethargic. He received further intravenous fluids whilst the medical officer discussed his presentation with the cardiology team.
After discussion with the patient