General

CaseStudy 2 _19112016 - Case of new atrial fibrillation

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19 Nov 2016 - General
 

An elderly woman, with history of hypertension, previous ischameic heart disease, previous stroke, peripheral vascular disease, osteoporosis, mild cognitive impairment, chronic kidney disease, and recently diagnosed metastatic breast cancer, was admitted to hospital due to sudden onset of palpitation, chest heaviness, and minimal shortness of breath. On arrival, patient was having fast atrial fibrillation (new), with the rate around 130-140 per minute, with blood pressure of around 150/90. Her oxygenen saturation was around 96% on room air. ECG showed fast atrial fibrillation. Chest X-ray showed no consolidation, urine dipstick was normal. Blood tests showed normal full blood count, normal CRP, stable renal function, with normal eletrolytes, normal thyroid function test and liver function test. Troponin level is elevated of twice the normal value. What is your differential diagnosis ? What is your treatment, investigation and management plan ??

According to a journal published by Dr. Michael Simons, he defined the common causes of chest heaviness as Unstable angina (UA) and non-ST elevation (non-Q wave) myocardial infarction (NSTEMI) wherein both differ primarily in whether the ischemia is severe enough to cause sufficient myocardial damage to release detectable quantities of a marker of myocardial injury. He mentioned in his article that Unstable angina is considered to be present in patients with ischemic symptoms suggestive of an AC...
 (Total 136 words)
Yes, acute coronary syndrome of non-ST elevation myocardial infarction will definitely an important diagnosis to treat and to further investigate. Given patient is also having on-going active metastatic cancer, pulmonary embolism will be another important differential diagnosis not to be missed. Hence, this patient should be treated with loading dose of dual antiplatelet, and therapeutic dose of low molecular weight heparin. In addition, b-blocker should be given to bring down the rate of patien...
 (Total 126 words)
In my opinion, this is a probable case of Acute Myocardial Infarction with Atrial Fibrillation.
I think acute MI is the primary diagnosis and atrial fibrillation is the complication of MI. One of the most common cause of atrial fibrillation is MI or ischaemic heart disease. The patient has multiple risk factors of MI. The presentation is typical and the troponin level is elevated.
The patient need immediate management of MI. Anticoagulation is essential to save her life. The AF can be m...
 (Total 114 words)