Case Rapid Atrial Explained for Students (Easy Guide)
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Original Question
Case #1: Rapid Atrial fibrillation 75 yo M admitted yesterday with 3 days of progressive SOB, cough, and fever. Physicial exam shows right sided crackles and hypoxia. CXR confirms RML infiltrate. Patient placed on O2 and admitted to the floor. This evening develops sudden increased SOB and palpatations, while returning from a smoke. No chest pain, no fevers, no chills. Now admitted to ICU as he develops Rapid A-fib. Past Medical History: CAD NSTEMI 2003 with RCA stent, NSTEMI 2010 with LAD stent x 2 CHF – secondary to ischemic cardiomyopathy, EF 45% Dyslipidemia HTN COPD Social History: Married with 2 children, lives at home with wife, worked as a mechanic, no alcohol or drugs. > 50 pack year smoking history Medications: Metoprolol 25mg po BID Ramipril 10 mg po Daily ASA 81 mg po Daily Plavix 75mg po Daily Lipitor 40 mg po Daily Spiriva 18mcg 1 puff inh Daily Initial Parameters: Patient: Patient uncomfortable, SOB, but able to answer questions. Vitals: HR 146 BP 95/50 (and dropping) RR 22 Temp 36.7 C O2 sat 93% on 3L Neuro: Eyes open, pupils equal and reactive Lungs: Crackles at bases R > L Cardiac: Normal S1, S2, no murmur, mild peripheral edema, elevated JVP Abdo: Soft, not tender, no masses Labs: AM Bloodwork (K Normal at 3.6, WBC 14.2, Glucose 8.9) CXR: RML infiltrate ECG: Rapid Atrial Fib (rate 143-168)-average HR is 146bpm Identify which medications your client is on that are important for cardiac health. (4 marks)
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