Mid-week Case study

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21 Jul 2016 - General

78 years old lady, of great baseline, independent in daily activity,  with the background history of Ischaemic heart disease, hypercholesterolaemia, hypertension, type 2 diabetes mellitus, was admiited to hospital due to few days history intermittent palpitation, with mild chest heaviness and general unwell. On examination, patient has irregular irrelgular pulse, with blood pressure of 130/85. Her ECG showed atrial fibrillation at the rate of betwen 100-110, with no ischaemic changes. Serial data of CK and Troponin T were negative. ECHO showed atrial fibrillation,EF of 55%, no regional wall akinesis. What is your proposed treatment and management strategy for this lady ?? And why do you do so ?

The primary treatment goals for the management of atrial fibrillation are: 1) Restoration of the normal rhythm, 2) Normalizing the heart rate 3) Prevention of complications by prevention of thrombosis 4) Primary prevention for stroke 5) Evaluation and prevention of heart failure 6) Screening for additional problems related to rhythm. After ruling out all potential secondary causes of fibrillation (such as drugs, thyroid problems etc), I would consider giving rate controllers such as beta-blocker...
 (Total 137 words)