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Abstract: A 67-year-old female patient presented to our hospital 20 days ago with palpitations, visual rotation with nausea and vomiting, and promptly consulted a local hospital for treatment, which was not effective. The electrocardiogram showed sinus rhythm and cardiac ultrasound showed mild tricuspid valve incompetence, and she was admitted to the hospital with tachycardia.
Basic information】Female, 67 years old
Disease Type】Tachycardia
Hospital】Senior Hospital of Central South University
Date of consultation】January 2022
Treatment plan】Minimally invasive surgery (radiofrequency ablation) + intravenous infusion (heparin sodium injection, cefoperazone sodium sulbactam sodium for injection) + oral medication (aspirin enteric dissolved tablets)
Treatment period】5 days of hospitalization, review after 2 weeks
Treatment effect] Palpitations disappeared and the condition was stable
I. Initial consultation
The patient was 67 years old and had palpitations and rotating vision with nausea and vomiting 20 days ago. On examination: heart rate of 98 beats/min, no pathological murmur, no murmur on auscultation of heart valves; electrocardiogram showed sinus rhythm with ST segment downward shift and T wave change in some leads. Cardiac ultrasound showed mild tricuspid valve insufficiency and normal left ventricular diastolic function. The preliminary diagnosis of tachycardia was made based on the patient’s complaints and relevant examination results, and the patient was admitted to the hospital.
II. Treatment history
After the patient was admitted to the hospital, the 48-hour ambulatory electrocardiogram showed sinus rhythm, paroxysmal atrial fibrillation, frequent premature atrial beats, and occasional multi-source premature ventricular beats, which was clearly diagnosed as tachycardia. After communication with the patient, he was treated with minimally invasive surgical cardiac radiofrequency ablation, and intracardiac electrophysiological examination was also performed. The patient was treated with symptomatic support after the operation, oral aspirin enteric tablets for antiplatelet coagulation, intravenous heparin sodium injection for anticoagulation, and cefoperazone sodium sulbactam sodium for injection for anti-infection treatment. 5 days later, the condition was stabilized, and the patient was discharged from the hospital and reviewed 2 weeks later.
III. Treatment results
The patient had a successful operation, normal postoperative blood pressure and heart rate, good general condition, and returned to the ward safely. One day after the operation, the patient reported that the palpitations were relieved compared with the previous symptoms, and there was no visual rotation, nausea or vomiting. After 5 days of hospitalization, the palpitations disappeared, and the examination showed that the heart border was not large, the heart rate was 90 beats/min, the rhythm was uniform, there was no murmur, the heart sound was acceptable, and there was no obvious abnormality, so the patient could be discharged home for recuperation after comprehensive consideration. 2 weeks later, the patient returned to the hospital for a review, and the ECG showed sinus rhythm and no other abnormalities, and the patient recovered well.
IV. Precautions
I was glad to see that the palpitations, nausea and vomiting improved and the patient was happy to be discharged from the hospital. I also advised the patient to pay attention to a low-salt and low-fat diet after going home, to keep his mood open, and to exercise moderately but avoid strenuous exercise. He should monitor his blood pressure and heart rate at home and come to the hospital regularly for routine blood tests, electrolytes, electrocardiogram and cardiac ultrasound to monitor changes in his condition. After going home, insist on taking medication regularly, especially you need to pay attention to the side effects of medication. After taking aspirin enteric soluble tablets orally, you should pay attention to whether there is bleeding from skin, mucous membrane, gums, black stool or vomiting blood.
V. Personal insight
The common symptoms of tachycardia are palpitations, chest tightness, shortness of breath, etc. When such uncomfortable symptoms appear, you should go to the hospital in time, and the prognosis is better through active treatment. Like the patient in this case, she was treated with minimally invasive surgery and medication after her symptoms appeared, and her condition was better controlled. If left untreated, long-term tachycardia can further affect heart function and cause serious consequences such as stroke, heart failure, and even sudden death. In addition, regular medical checkups can help detect the disease early and provide timely treatment.