Cardiovascular Patient B


The following is a patient described in New England Journal of Medicine, 2004, vol. 351, pages 2408-16.

A 77-year-old woman with a history of hypertension ... presents for her annual examination. She reports no new symptoms. The examination is remarkable only for the finding of an irregular heart rate. Electrocardiographic testing reveals atrial fibrillation..... She has no history of arrhythmia, coronary disease, valvular disease, diabetes, alcohol abuse, transient ischemic attack, or stroke. For the past several months, she has exercised on a treadmill without difficulty, although she notes that the machine does not always measure her heart rate.




QUESTION: The initial observation was an "irregular heart rate". More specifically, what would the electrocardiogram look like?

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QUESTION: Is this the permanent or paroxysmal form of atrial fibrillation?

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QUESTION: Is it unusual for atrial fibrillation to be asymptomatic, so that it might only discovered in a yearly examination (or if it results in a stroke)?

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QUESTION: But if her atria are not pumping blood, how can she exercise normally on a treadmill???

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She was put on metoprolol, which brought her heart rate down to 75.


QUESTION: What type of drug is metoprolol?

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QUESTION: Is the doctor attempting "rate control" or "rhythm control"?

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QUESTION: The term "cardioversion" refers to coverting the heart beat to its normal sinoatrial rhythm. In this case, wouldn't it be better to attempt the cardioversion so the heart is beating with a normal rhythm?

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QUESTION: Is anticoagulation indicated even in this asymptomatic patient?

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QUESTION: What else is indicated for this patient?

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