Monday, April 10, 2006

Reply to last weeks case study

We put up a case study last week and two posters replied. Well here's a reply.

No, this is not Atrial Fib., I am sorry. In AF, the rhythm should be irregularly irregular. No two R-R interval will be the same.

I must say that some leads does looks like it could be A.Flutter. But no, mr MM is in Sinus rhythm. You are right, diuretics (like lasix) to control the congestive symptoms is correct. The BP control could be better. The target is 130/85mmHg or less. By the guidelines, the prefered is ACE-I (or ARBs in those who are ACE-I intolerant). Beta-blocker s like carvidelol or metoprolol tartrate or succinate or bisoprolol could also be used. All these agents help to improve symptoms and also prolong life. Aldosterone antagonist can also be used to relief symptoms and prolong life, but when they are used together with ACE-I, hyperkalemia is a very real danger, and close serum K+ monitoring is required.

This patient also has CAD on ECG (many ischemic changes), with very important coronary risk factors. Smoking, NIDDM, HBP, has to be managed too. Heart failure is better prevented by good control of known risk factors.We must learn to view heart failure as a malignant disease. For Mr MM, unless ACE-I/ARBs/Beta-blockers/aldosterone antagonist is used, the 5yr mortality could be 20-30%.

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