Pharmacology of Arrhythmias
Case study-based activity. Patient with irregular cardiac rhythm
On winter morning, Dr. CA, a 56-year-old professor, is lecturing on the treatment of cardiomyopathies to the second year university students. He feels his heart beating irregular and becomes nauseated. He is able to finish his lecture but he continues to feel significantly short of breath throughout the morning. His persistent symptoms prompt him to walk down the street to the local emergency department.
Physical examination reveals an irregular heart beat ranging from 120 to 140 beats/min. Dr.CA’s blood pressure is stable (132/76 mmHg), and his oxygen saturation is 100% on room air. An electrocardiogram (ECG) confirms that Dr. CA has atrial fibrillation, without any evidence of ischemia. Several intravenous boluses of diltiazem are administered, and his heart rate decreases to a range of 80 – 100 beats/min but his rhythm remains irregular. Further laboratory studies and chest x-ray do not reveal an underlying cause for Dr. CA’s atrial fibrillation.
During observation over the next 12 hours, Dr. CA remains in atrial fibrillation. Although his heart rate is under better control, he continues to experience palpitations. Under continuous ECG monitoring, a cardiologist administers an intravenous injection of ibutilide. Twenty minutes later after receiving the ibutilide, Dr. CA’s ECG shows a return to normal sinus rhythm. Based on his age and generally good health, Dr. CA is sent home with a prescription for aspirin.
He is instructed to call his doctor if he develops further symptoms of atrial fibrillation.
Dr. CA. feels fine at first, but he develops recurrent palpitations within 3 weeks of his initial event. After discussion with cardiologist, he elects to start amiodarone at a maintenance dose of 200mg/day, in aIDition to continuing aspirin. Dr. CA. tolerates the amiodarone well and reports no difficulty breathing. He remains symptom-free during the rest of his cardiology lectures.
QUESTIONS:
1. Why did diltiazem slow Dr. CA’s heart rate without affecting his underlying heart rhythm, atrial fibrillation?
2. Why should ibutilidebe administered only under carefully monitored circumstances?
3. Why were ibutilideand amiodarone effective in converting Dr. CA’s rhythm to normal?
4. What adverse effects of amiodarone could develop at higher daily doses or during prolonged period of treatment (6 or 12 months)?
5. How action potential of cardiac cells will be affected by the antiarrhythmics given to him for the treatment?
5 A. Diltiazam IV
5B. Ibutilide IV.
5. C. Amiodarone
6. Present the most common side effects and reasons for monitoring in case of use of these antiarrhythmics:
6A. Diltiazam IV
6B. Ibutilide IV
6C. Amiodarone IV –
Why Work with Us
Top Quality and Well-Researched Papers
We always make sure that writers follow all your instructions precisely. You can choose your academic level: high school, college/university or professional, and we will assign a writer who has a respective degree.
Professional and Experienced Academic Writers
We have a team of professional writers with experience in academic and business writing. Many are native speakers and able to perform any task for which you need help.
Free Unlimited Revisions
If you think we missed something, send your order for a free revision. You have 10 days to submit the order for review after you have received the final document. You can do this yourself after logging into your personal account or by contacting our support.
Prompt Delivery and 100% Money-Back-Guarantee
All papers are always delivered on time. In case we need more time to master your paper, we may contact you regarding the deadline extension. In case you cannot provide us with more time, a 100% refund is guaranteed.
Original & Confidential
We use several writing tools checks to ensure that all documents you receive are free from plagiarism. Our editors carefully review all quotations in the text. We also promise maximum confidentiality in all of our services.
24/7 Customer Support
Our support agents are available 24 hours a day 7 days a week and committed to providing you with the best customer experience. Get in touch whenever you need any assistance.
Try it now!
How it works?
Follow these simple steps to get your paper done
Place your order
Fill in the order form and provide all details of your assignment.
Proceed with the payment
Choose the payment system that suits you most.
Receive the final file
Once your paper is ready, we will email it to you.
Our Services
No need to work on your paper at night. Sleep tight, we will cover your back. We offer all kinds of writing services.
Essays
No matter what kind of academic paper you need and how urgent you need it, you are welcome to choose your academic level and the type of your paper at an affordable price. We take care of all your paper needs and give a 24/7 customer care support system.
Admissions
Admission Essays & Business Writing Help
An admission essay is an essay or other written statement by a candidate, often a potential student enrolling in a college, university, or graduate school. You can be rest assurred that through our service we will write the best admission essay for you.
Reviews
Editing Support
Our academic writers and editors make the necessary changes to your paper so that it is polished. We also format your document by correctly quoting the sources and creating reference lists in the formats APA, Harvard, MLA, Chicago / Turabian.
Reviews
Revision Support
If you think your paper could be improved, you can request a review. In this case, your paper will be checked by the writer or assigned to an editor. You can use this option as many times as you see fit. This is free because we want you to be completely satisfied with the service offered.