2016 Quiz

  • The ECG shows atrial fibrillation (AF)- this is common in older patients and may be not cause any symptoms. However AF is associated with an increased risk of stroke/ thromboembolism- it is likely that this was the cause for the patient’s previous mini-stroke.
  • Recommended tests-
    • Echocardiogram- to cardiac size and function and look for any valvular heart disease
    • 24 hour Holter monitor- assess AF rate over a longer period of time
    • Blood tests- check renal function, thyroid function and full blood count
    • Consider assessment for coronary artery disease (e.g treadmill test, CT calcium score/ CT coronary angiogram)
  • Management-
    • The patient should be started on oral anticoagulation (either warfarin or a novel oral anticoagulant) to reduce his risk of stroke/ thromboembolism
    • The amlodipine should be changed to a beta-blocker which can control both is blood pressure and AF rate