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Old 04-15-2012
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Heart Management of Atrial Fibrillation?

A 63-year-old man presents to the emergency room, because of an abnormal heart rate. He states that he has a conscious awareness of his heart beating and has noticed several palpitations over the last hour. He currently suffers from congestive heart failure (CHF) and type II diabetes mellitus (DM). At present, he takes furosemide, lisinopril, aspirin, simvastatin, and insulin.
There is mild bilateral pitting edema at the ankles. The electrocardiogram reveals an atrial rate of 350 beats/minute, a ventricular rate of 105 beats/minute, irregularly irregular R-R intervals, and absent P waves.
What is the most appropriate next step in the management of this patient?

A. Begin digoxin
B. Begin dobutamine
C. Begin metoprolol
D. Begin spironolactone
E. Begin verapamil
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Old 04-15-2012
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C. Begin metoprolol
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Old 04-15-2012
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C. Begin metoprolol
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C. Begin metoprolol
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is it A?
for Afib if the patient is stable then we have to correct the rate by giving beta blocker or CCB based on other comorbid conditions.If patient has heart failure Hx,give Digoxin.
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Old 04-15-2012
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Quote:
Originally Posted by aiminghigh View Post
is it A?
for Afib if the patient is stable then we have to correct the rate by giving beta blocker or CCB based on other comorbid conditions.If patient has heart failure Hx,give Digoxin.
ya, ans is digoxin
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Old 04-16-2012
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I wonder why we can't give metoprolol in chf+afib in this case
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Old 04-16-2012
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Quote:
Originally Posted by tyagee View Post
I wonder why we can't give metoprolol in chf+afib in this case
May be because although Metoprolol will lower the HR & contractility..it can worsen the condition if the patient has decompensated Heart failure.
Digoxin on the other hand improve CHF as well as effective for arrhythmia.


I AM NOT SURE THOUGH.JUST MY THOUGHT.
Please feel free to correct me
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Quote:
Originally Posted by aiminghigh View Post
May be because although Metoprolol will lower the HR & contractility..it can worsen the condition if the patient has decompensated Heart failure.
Digoxin on the other hand improve CHF as well as effective for arrhythmia.


I AM NOT SURE THOUGH.JUST MY THOUGHT.
Please feel free to correct me
yes i remember we should not give betablocker even though cardioselectives in decompensated chf...so its digoxin as it control heart rate for afib and symptom relief in chf as positive inotropic effect
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Old 10-25-2014
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Quote:
Originally Posted by tyagee View Post
ya, ans is digoxin
Why not Calcium blocker? it also works for Afib
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Old 11-03-2014
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Quote:
Originally Posted by paraguayman View Post
Why not Calcium blocker? it also works for Afib
drug of choice for RATE CONTROL in a fib in compensted heart failure patient is
ALWAYS A BETA BLOCKER(carvedilol,metaprolol succinate,bisoprolol)
CCB NOT PREFERRED OVER BETA BLOCKER DUE TO HIGHER MORTALITY(uptodate)
if beta blocker not successful even after dose adjustments,consider adding DIGOXIN

for patient with decompensated heart failure + a fib
beta blocker contraindicated
DOC-digoxin
digoxin controls ventricular rate
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