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Abstract: The subject of this case is a 59-year-old aunt. The patient reported that she had a sudden onset of palpitations today, triggered by an argument with her family, and the palpitations had been going on for 3-4 hours without any sign of improvement, so she was seen at our hospital. The patient had hypertension in the past and her blood pressure was controlled at 140/90 mmHg. After comprehensive examination and ECG, she was diagnosed with palpitations, arrhythmia, paroxysmal atrial fibrillation and hypertension.
Basic information】Female, 59 years old
Disease Type】Palpitations, arrhythmia, paroxysmal atrial fibrillation, hypertension
Hospital】Harbin First Hospital
Date of Consultation】May 2022
Treatment plan】Medication (amiodarone hydrochloride injection, low molecular heparin sodium injection, amiodarone hydrochloride tablets, dabigatranate capsules)
Treatment period】5 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】The palpitations disappeared completely, paroxysmal atrial fibrillation returned to sinus rhythm, and all indexes improved.
I. Initial consultation
I was on duty in the ward today, and a 59-year-old aunt accompanied by her family came to the ward with a hospitalization order. After detailed communication with the patient and her family, I learned that the patient had a sudden onset of palpitations today, triggered by an argument with her family. He was diagnosed with primary hypertension about 6 years ago, and his blood pressure was controlled below 140/90 mmHg with regular oral perindopril tablets. After admission, an electrocardiogram showed arrhythmia and paroxysmal atrial fibrillation. The preliminary diagnosis of palpitations, arrhythmia, paroxysmal atrial fibrillation and hypertension was based on the ECG and physical findings.
(Electrocardiogram)
II. Treatment
First of all, the patient was treated as soon as possible to restore sinus rhythm, first with amiodarone hydrochloride injection, then with amiodarone hydrochloride injection, and at the same time with subcutaneous injection of low molecular heparin sodium. The patient returned to sinus rhythm and atrial fibrillation was corrected after about 1 hour of drug administration. The patient was then instructed to take oral amiodarone hydrochloride tablets for 1 month, and then to gradually reduce the dosage and stop taking them. During the course of treatment, the causes of atrial fibrillation were investigated, and the five items of A-alpha, routine blood, cardiac ultrasound, coronary CT, serum ions and 24-hour ambulatory ECG were performed, but no significant abnormalities were found. According to the CHA2DS2-VASc score (score for non-valvular atrial fibrillation, risk of stroke), this patient had a score of 2. If the score is greater than or equal to 2, anticoagulation therapy is required. Therefore, the patient was discharged after 5 days of hospitalization. After discharge, the patient was instructed to take oral dabigatranate capsules for anticoagulation and to gradually reduce the dosage of amiodarone hydrochloride tablets and stop taking them after 1 month, and to come to the outpatient clinic for follow-up.
III. Treatment effect
On the day of hospitalization, the paroxysmal atrial fibrillation returned to sinus rhythm, and the patient’s palpitations disappeared. The patient was discharged after 5 days of hospitalization, and the ECG was rechecked at the time of discharge: sinus rhythm, normal ECG; the blood pressure was basically controlled below 130/80 mmHg; the heart rate could generally be maintained below 70 beats/min. The patient had no hypotension or bradycardia problems while taking antiarrhythmic drugs, and there was no atrial fibrillation without recurrence during the treatment. There was no prolongation of Q-T interval in the electrocardiogram, and the rest of the indexes improved. In conclusion, the patient’s palpitations completely disappeared, paroxysmal atrial fibrillation returned to sinus rhythm, and all indexes improved.
IV. Notes
We are sincerely happy that the patient’s condition has been relieved through treatment. In daily life, it is necessary to avoid excessive emotional excitement and maintain a calm state of mind; on the diet, a low-salt, low-fat diet, light and nutritious, more fresh fruits and vegetables, and increased intake of whole grains.
In daily life, pay attention to monitoring heart rate and blood pressure, and take relevant oral antihypertensive drugs on time. After complete discontinuation of amiodarone hydrochloride tablets, it is advisable to combine them with medications to stabilize sinus rhythm, such as metoprolol tartrate tablets instead of amiodarone hydrochloride tablets. During the period of taking anticoagulant drugs, pay attention to whether there is any bleeding tendency, for example, whether there is gum bleeding when brushing teeth or subcutaneous bleeding after bumping, etc. If there is any abnormality, patients should seek medical attention promptly. Patients need to go to the hospital every six months to a year or so to review the electrocardiogram, cardiac ultrasound, blood routine, urine routine, macrobiochemistry and other related tests.
V. Personal insight
Patients with palpitations should not be taken lightly, as the symptoms can be large or small. Some patients may simply have a disturbance in the regulation of vegetative nerves, while others may have arrhythmias, such as atrial fibrillation. In patients with atrial fibrillation, attention should be paid to the conversion of sinus rhythm and anticoagulation therapy as soon as possible to help avoid thromboembolic events. For paroxysmal atrial fibrillation not caused by valve disease, patients are advised to prefer new oral anticoagulants, such as dabigatranate capsules and rivaroxaban tablets, which are relatively less risky for bleeding. While treating atrial fibrillation or improving the symptoms of palpitations, it is important to find out whether there are other diseases associated with it, improve the relevant tests and treat the primary disease in order to reap better results. If the cause of atrial fibrillation is not found, it is necessary to do secondary prevention treatment.