A 30-year-old male with a history of paroxysmal (from time to time) atrial dysrh

Question

A 30-year-old male with a history of paroxysmal (from time to time) atrial dysrhythmias reports to the emergency room complaining of shortness of breath, dizziness, and intermittent heart palpitations. He holds a somewhat stressful job as an accountant with a local accounting firm, lives alone, and participates regularly in physical activities, playing in a local amateur soccer league. The patient reports that he is taking quinidine to control his dysrhythmias, and that he has been stable on this medication for about 2 years without any episodes, but that he occasionally misses doses when he gets busy.

The patient undergoes a physical assessment and is given an ECG. The results of the examination and ECG are as follows:

Neurological: AAOx3 (patient is awake, aware, and oriented to place, time, and person)

Pulmonary: Normal, with slightly increased respiratory rate

Gastrointestinal: Normal bowel sounds, but patient complains of intermittent nausea

Genitourinary: Normal, no patient complaints

Cardiovascular: Rapid, irregular pulse; patient complains of chest pain and occasional heart palpitations

Vitals: HR 152 and irregular; respiratory rate 29/min; BP 100/52; Temp 36.8 C; O2 saturation 96%

Medications: Quinidine 400mg 3xday; multivitamin; aspirin 80mg/day

Labs: Na+ 135 mEq/L; K+ 2.9 mEq/L; BUN 27; creatinine 1.4 mg/dL; fasting blood glucose 99 mg/dL

ECG- abnormal

1. What type of dysrhythmia does this patient have?

2. What are the characteristics of this type of dysrhythmia, as compared to a normal ECG?

3. What is the most likely cause of this dysrhythmia? (refer to the lab results above)

4. What would be the best immediate treatment for this patient.

5. Does this patient have a good or a poor prognosis (long-term outlook)? Explain your answer fully.

Explanation / Answer

1. According to above scenaro,it is clear that the patient s having paroxysmal atrial fibrilation. He complains of shortness of breath,intermttent dizziness and palpitaton and intermttent nausea which confirm the diagonosis . Also the risk factors of AF such as stressful life conditions, increased physical activities and age results the condition.

2.As compared with normal ECG, this type of dysarrythma is havng irregularly irregular heart rythm, absence of P wave, absence of soelectrc baselne, variable ventricular rate,QRS complex usually <120ms , fibrilatory waves may present which may mimic P waves.

3. Based on the available lab results, this dysarrythmia might come under slow AF, as patient s havng hypothermia and hypokalemia

4. The best immediate treatment for this patient include rate control and ant coagulation therapy. Restoration of sinus rhythm with regularization of hearts rhythm improve cardiac hemodynamics and exercise tolerance.It would be achieved through AF ablation. Another risk is stroke and inorder to prevent that, anticoagulation therapy is nesessary.

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