USMLE Forum Archives - USMLE Step 3 - Atrial fibrillation
Atrial fibrillation
zkadhem - 08-03-09 16:07
A 44-year-old Chinese-American man comes to the physician because of palpitations. He denies any chest pain or shortness of breath. He has no other medical problems. He denies any history of rheumatic fever in the past. The patient is a pathologist and works 10 to 12 hours daily. He does not use tobacco, alcohol, or drugs. His family history is not significant. He takes no medications. His pulse is 162/min. Electrocardiogram shows atrial fibrillation. The patient’s rate is effectively controlled with metoprolol. His CBC, basic metabolic panel, TSH, and chest x-ray are normal. Serial cardiac enzymes were negative. D-dimer is within normal limits. A 2D-echocardiogram is done, which reveals no structural abnormalities. Which of the following is the most effective therapy to decrease this patient"s risk for developing a stroke?
zkadhem - 08-03-09 16:07
A 44-year-old Chinese-American man comes to the physician because of palpitations. He denies any chest pain or shortness of breath. He has no other medical problems. He denies any history of rheumatic fever in the past. The patient is a pathologist and works 10 to 12 hours daily. He does not use tobacco, alcohol, or drugs. His family history is not significant. He takes no medications. His pulse is 162/min. Electrocardiogram shows atrial fibrillation. The patient’s rate is effectively controlled with metoprolol. His CBC, basic metabolic panel, TSH, and chest x-ray are normal. Serial cardiac enzymes were negative. D-dimer is within normal limits. A 2D-echocardiogram is done, which reveals no structural abnormalities. Which of the following is the most effective therapy to decrease this patient"s risk for developing a stroke?
The correct answer and explanation will be available after you answer.
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#2
Re: Atrial fibrillation bingousmle - 08-03-09 16:14 should have read it properly of course its stroke..n not embolism.. could you mention the indications of warfarin in afib
#3
Re: Atrial fibrillation
zkadhem - 08-03-09 16:19 the concept in this question is about the LONE ATRIAL FIBRILLATION.
Atrial fibrillation that is secondary to some other conditions
(i.e. coronary artery disease, thyroid dysfunction, pulmonary embolism, congestive heart failure, valvular heart disease,
COPD, diabetes mellitus type-2, hypertension ) is more likely to cause stroke secondary to showering of emboli, so here we need to put the patient onsome type of anticoagulant like warfarin!
Heparin is used at the beginning when we need to do cardioversion to convert A.Fib into normal sinus rhythm specially whenthe A.Fib is chroninc i,e > 48 hours.
#4
Re: Atrial fibrillation bingousmle - 08-03-09 16:25 that means that a patient with any of the above mentioned conditions who develops atrial fibrillation secondarily needs to be given warfarin... and the ones with lone afib need to be given aspirin. but i dont understand why do you need to give him any prophylaxis in first place? and is he not at risk to develop atrial thombus?
#5
Re: Atrial fibrillation zkadhem - 08-03-09 16:47 Lone atrial fibrillation in a patient younger than 60 years of age and without structural or functional cardiac abnormalities does not increase the risk of stroke. However, small
studies suggest that there can be some risk, especially if the patient has other risk factors, such as advanced age, diabetes, or hypertension. For this reason, aspirin is recommended as prophylactic therapy. The risk of anticoagulation with Coumadin outweighs the benefits in this setting.
I hope this answer your question.
Thanks
#21
Re: Atrial fibrillation babbu5508 - 08-31-10 13:21 My answer is: c.
the condition represents lone atrial fibrillation...there is a risk of embolisation of a thrombus that can form in the atrium...
#23
Re: Atrial fibrillation patri226 - 09-11-10 15:42 My answer is: b.
studies have shown clopidogrel to be superior to aspirin in prevetion of stroke
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