👨⚕⏰ Q. How to treat atrial fibrillation? 🫀
Please open Telegram to view this post
VIEW IN TELEGRAM
internal medicine
👨⚕⏰ Q. How to treat atrial fibrillation? 🫀
👨🏻⚕A. Aim of treatment is as follows:
✓ Control of heart rate
✓ Restoration of sinus rhythm and prevention of recurrence
✓ Treatment of primary cause.
Treatment (according to the type):
1. Paroxysmal atrial fibrillation:
x If asymptomatic: Does not require any treatment, follow-up the case.
x If troublesome symptoms are present: b-blocker. Other drugs—flecainide or propafenone may
be given.
x Amiodarone is effective in prevention.
x Low dose aspirin to prevent thromboembolism.
x If bradycardia is present (in sinoatrial disease): Permanent over drive atrial pacing (60%
effective).
x In some intractable cases: Radiofrequency ablation may be required, who does not have
structural heart disease (70% effective).
2. Persistent atrial fibrillation:
x Control of heart rate: b-blocker, digoxin or calcium channel blocker (verapamil, diltiazem).
Combination of digoxin and atenolol may be used.
x To control rhythm: DC cardioversion may be done safely. It may be repeated, if relapse occurs.
Concomitant use of b-blocker or amiodarone may be used to prevent recurrence.
3. Permanent atrial fibrillation:
x Control of heart rate: Digoxin, b-blocker, calcium channel blocker (verapamil or diltiazem).
x In some cases: Transvenous radiofrequency ablation may be done (it induces complete heart
block. So, permanent pacemaker should be given. This is known as “patch and ablate strategy”).
✓ Control of heart rate
✓ Restoration of sinus rhythm and prevention of recurrence
✓ Treatment of primary cause.
Treatment (according to the type):
1. Paroxysmal atrial fibrillation:
x If asymptomatic: Does not require any treatment, follow-up the case.
x If troublesome symptoms are present: b-blocker. Other drugs—flecainide or propafenone may
be given.
x Amiodarone is effective in prevention.
x Low dose aspirin to prevent thromboembolism.
x If bradycardia is present (in sinoatrial disease): Permanent over drive atrial pacing (60%
effective).
x In some intractable cases: Radiofrequency ablation may be required, who does not have
structural heart disease (70% effective).
2. Persistent atrial fibrillation:
x Control of heart rate: b-blocker, digoxin or calcium channel blocker (verapamil, diltiazem).
Combination of digoxin and atenolol may be used.
x To control rhythm: DC cardioversion may be done safely. It may be repeated, if relapse occurs.
Concomitant use of b-blocker or amiodarone may be used to prevent recurrence.
3. Permanent atrial fibrillation:
x Control of heart rate: Digoxin, b-blocker, calcium channel blocker (verapamil or diltiazem).
x In some cases: Transvenous radiofrequency ablation may be done (it induces complete heart
block. So, permanent pacemaker should be given. This is known as “patch and ablate strategy”).
Forwarded from يعقوب السميعي
عيد مبارك وكل عام وأنتم بخير. 🐑
Eid Mubarak
Eid Mubarak
“If you focus on results, you will
never change. If you focus on
change, you will get results”
never change. If you focus on
change, you will get results”
internal medicine
👨⚕Q. What is the role of anticoagulant in atrial fibrillation?
🧑⚕ How are you 😊 for everyone ?
🧑⚕ Answer is:
A. Usually, warfarin is given who are at risk of stroke. Target INR is 2 to 3. It reduces stroke in 2/3rd
cases. Aspirin reduces stroke in 1/5th cases. Anticoagulation is indicated in patient with atrial
fibrillation having risk factors for thromboembolism.
🧑⚕Risk factors for thromboembolism in atrial fibrillation:
✓Previous ischaemic stroke or TIA
✓ Mitral valve disease
✓Age over 65 years
✓Hypertension
✓ Diabetes mellitus
✓Heart failure
✓ Echocardiographic evidence of left ventricular dysfunction, left atrial enlargement or mitral anular
calcification.
🔽 Risk groups with thromboembolism (nonrheumatic):
✓Very high: Previous stroke or TIA (12%)
✓ High: Age > 65 years and one other risk factor (6.5%)
✓ Moderate: (i) Age > 65 years, no risk factor (4%), (ii) Age < 65 years, other risk factor (4%)
✓ Low: Age < 65 years, no risk factor (1.2%).
🧑⚕also Score as comments you read CHA2DS2-VASc score
🧑⚕ Answer is:
A. Usually, warfarin is given who are at risk of stroke. Target INR is 2 to 3. It reduces stroke in 2/3rd
cases. Aspirin reduces stroke in 1/5th cases. Anticoagulation is indicated in patient with atrial
fibrillation having risk factors for thromboembolism.
🧑⚕Risk factors for thromboembolism in atrial fibrillation:
✓Previous ischaemic stroke or TIA
✓ Mitral valve disease
✓Age over 65 years
✓Hypertension
✓ Diabetes mellitus
✓Heart failure
✓ Echocardiographic evidence of left ventricular dysfunction, left atrial enlargement or mitral anular
calcification.
✓Very high: Previous stroke or TIA (12%)
✓ High: Age > 65 years and one other risk factor (6.5%)
✓ Moderate: (i) Age > 65 years, no risk factor (4%), (ii) Age < 65 years, other risk factor (4%)
✓ Low: Age < 65 years, no risk factor (1.2%).
🧑⚕also Score as comments you read CHA2DS2-VASc score
Please open Telegram to view this post
VIEW IN TELEGRAM
Cardiovascular system
⭕ Pulse: 88/min, normal in volume, rhythm and character
⭕ JVP: not engorged
⭕ Blood pressure: 130/85 mm Hg.
Precordium
Inspection:
⭕ Visible cardiac impulse in mitral area.
Palpation:
⭕ Apex beat: shifted, in the left 6th intercostal space, ... cm from midline, diffuse, thrusting in
character
⭕ Thrill: present in left 6th intercostal space, systolic in nature.
Auscultation:
⭕ 1st heart sound: soft in mitral area, normal in other areas
⭕ 2nd sound: normal in all the areas
⭕ 3rd heart sound: may be present
⭕ There is a pansystolic murmur in mitral area, which radiates to the left axilla (reduced on inspiration
and more on expiration).
Examination of other systems reveals no abnormalities.
Precordium
Inspection:
Palpation:
character
Auscultation:
and more on expiration).
Examination of other systems reveals no abnormalities.
Please open Telegram to view this post
VIEW IN TELEGRAM
internal medicine
Cardiovascular system ⭕ Pulse: 88/min, normal in volume, rhythm and character ⭕ JVP: not engorged ⭕ Blood pressure: 130/85 mm Hg. Precordium Inspection: ⭕ Visible cardiac impulse in mitral area. Palpation: ⭕ Apex beat: shifted, in the left 6th intercostal space…
Please open Telegram to view this post
VIEW IN TELEGRAM
internal medicine
🧑🏼⚕ My diagnosis is chronic rheumatic heart disease with mitral regurgitation.
internal medicine
🧑🏼⚕ My diagnosis is chronic rheumatic heart disease with mitral regurgitation.
👨🏻⚕Q. Why your diagnosis is MR?
internal medicine
👨🏻⚕Q. Why your diagnosis is MR?
🧑🏼⚕A. Because:
✓ Systolic thrill in mitral area
✓ First heart sound is soft
✓ There is a PSM radiating to the left axilla.
✓ Systolic thrill in mitral area
✓ First heart sound is soft
✓ There is a PSM radiating to the left axilla.
Forwarded from Yaqob Hamood
Real case ABG
PH = 6.98
CO2 = 12 mmHg
HCO3 = 4.4 mmol/L
Read this ABG ?
PH = 6.98
CO2 = 12 mmHg
HCO3 = 4.4 mmol/L
Read this ABG ?
Forwarded from Yaqob Hamood
🧑⚕Firstly Acidosis
👨⚕ Why ?
🧑⚕PH less than 7.35
👨⚕ Metabolic or respiratory?
🧑⚕ Metabolic
👨⚕ Why ?
🧑⚕ Because Bicarbonate is low and CO2 is low , Co2 low as compensation
👨⚕is compensation or partially compensation or not compensation ?
🧑⚕ partial compensation
👨⚕ Why ?
🧑⚕ Because CO2 low PH low
👨⚕ Why you didn't say compelet compensation ?
🧑⚕ Because in compelet compensation PH must be normal , in this case PH is abnormal
👨⚕ Why you didn't say uncompensation ?
🧑⚕ Firstly HCo3 it's primary disorder as it's low and PH is low ....if uncompensation CO2 must be normal
👨⚕ok .... what you want to see after your dx as Metabolic Acidosis ?
🧑⚕i will calculate Anion Gap
👨⚕ Why ?
🧑⚕ To know the cause of metabolic acidosis ,,as there is causes of metabolic Acidosis with normal Anion Gap ,,also there's causes for High anion Gap Metabolic Acidosis
👨⚕ How you calculate Anion Gap ?
What is the causes of High Anion Gap Metabolic Acidosis , causes of Normal Anion Gap Metabolic Acidosis ?
🧑⚕ Let members Answer , help me members ?
👨⚕ Why ?
🧑⚕PH less than 7.35
👨⚕ Metabolic or respiratory?
🧑⚕ Metabolic
👨⚕ Why ?
🧑⚕ Because Bicarbonate is low and CO2 is low , Co2 low as compensation
👨⚕is compensation or partially compensation or not compensation ?
🧑⚕ partial compensation
👨⚕ Why ?
🧑⚕ Because CO2 low PH low
👨⚕ Why you didn't say compelet compensation ?
🧑⚕ Because in compelet compensation PH must be normal , in this case PH is abnormal
👨⚕ Why you didn't say uncompensation ?
🧑⚕ Firstly HCo3 it's primary disorder as it's low and PH is low ....if uncompensation CO2 must be normal
👨⚕ok .... what you want to see after your dx as Metabolic Acidosis ?
🧑⚕i will calculate Anion Gap
👨⚕ Why ?
🧑⚕ To know the cause of metabolic acidosis ,,as there is causes of metabolic Acidosis with normal Anion Gap ,,also there's causes for High anion Gap Metabolic Acidosis
👨⚕ How you calculate Anion Gap ?
What is the causes of High Anion Gap Metabolic Acidosis , causes of Normal Anion Gap Metabolic Acidosis ?
🧑⚕ Let members Answer , help me members ?