Atrial Fibrillation in a Patient with Heart Failure – Clinical Patient Case of the Week

Andrea Eberly, MD, MS, FAAEMClinical Pearls, Emergency Medicine, Family Medicine, Guideline Knowledge Check, Internal Medicine, Nurse Practitioner, Nursing RN/PN, Pediatric Emergency Medicine, Pediatric Medicine, Personal Education, Physician Assistant, Urgent Care

Atrial Fibrillation - paroxysmal (intermittent) symptomatic atrial fibrillation in a patient with heart failure - Clinical Patient Case of the Week

Atrial Fibrillation with Heart Failure - Clinical Patient Case of the Week

Try this free Atrial Fibrillation Case Q&A courtesy of Med-Challenger.

This atrial fibrillation case comes from our Internal Medicine course, part of Med-Challenger's library of board exam review and CME question banks.

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Try this case and test your knowledge of atrial fibrillation with heart failure.

A 76-year-old man with a left ventricular ejection fraction of 35% presents with episodes of palpitations accompanied by significant dyspnea and near syncope. The episodes occur several times a day and spontaneously terminate. His current medications include lisinopril, carvedilol, furosemide, aspirin, and atorvastatin.

Upon presentation, he has a regular pulse of 90 beats/minute and blood pressure of 110/78 mm Hg.  An initial ECG showed normal rate and rhythm. His electrolyte level and renal function are normal, as is his thyroid-stimulating hormone level. The monitor shows normal sinus rhythm.

While he is being observed, the patient becomes dyspneic, dusky-colored, and lightheaded. You obtain an electrocardiogram (ECG; see Figure).

After several minutes, the patient spontaneously reverts to a sinus rhythm and his symptoms abate.


Which antiarrhythmic drug could be considered in this particular patient to maintain a sinus rhythm and thus protect the patient from arrhythmia-related near-syncope?

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