In 1- to 2-pages, reflect on a patient with a known history of a cardiovascular disorder such as a blood clot or arrhythmia. Describe the patient’s personal and medical history, drug therapy and treatments, and follow-up care. If you did not evaluate a patient with this background during the last four weeks, you may select a related case study from a reputable source or reflect on previous clinical experiences
Primary Care of Adults across the Lifespan
Primary Care of Adults across the Lifespan
Cardiovascular disorders exist in various forms and they affect the functionality and structures of an individual’s heart. Some of these disorders are arrhythmia, Marfan syndrome, cardiomyopathy, pericardial disease, blood clots, and the rheumatic heart disease among others. This reflection features a 23-year-old patient with a known history of arrhythmia, which is a condition that is associated with irregular heartbeats. The patient has a history of alcohol and substance abuse that are based on significant levels of anxiety and stress. She has also been taking some over the counter nutritional supplements although there is no detailed medical history concerning the same. It was during a stress test, by exercising on a stationary bicycle, that the doctor realized that the patient’s heart activity was monitored. The patient was then subjected to an Electrocardiogram (ECG) that uses electrodes to measure the duration of every electrical phase of the individual’s heartbeat (AlKabani & AlRawahi, 2019). It was then discovered that the patient was suffering from atrial fibrillation that involves irregular rhythms that lead to a low coordination in the atrial contraction.
The drug therapy and treatments are geared towards controlling the heart rate and eventually restoring the patient’s heart rhythm back to normal. Since this patient’s condition is atrial fibrillation, the prescriptions offered have to be blood-thinning medications. These medications would help to ensure that the dangerous blood clots are kept from forming. One of the common medications for such a patient is amiodarone that may include pacerone and cordarone (Sapp et al., 2016). The patient could also be prescribed the ibutilide medication or covert in particular as well as lidocaine that is only allocated through IV. Other forms of treatment include vagal maneuvers that are structured around the patient holding her breath to a point of straining or coughing. The patient could also practice dunking her face in a bucket of ice water to control the heart beats. These maneuvers begin at the supraventricular tachycardia which is the lower half of the heart and proceed to affect the vagus nerve which is the part of the nervous system that controls breathing. As a result, the vagal maneuvers cause the pulse to slow. Although such a form of treatment is not effective for some types of arrhythmias, it can produce substantial results for this patient with atrial fibrillation. The other form of treatment that is relatively effective is cardioversion whereby patches or paddles are used to deliver a shock to the heart (Marruoche et al., 2018). These currents are capable of restoring the heart’s rhythm back to normal as they target its electrical impulses.
Although the medications are capable of managing the condition, there is a chance of the patient having a reoccurrence of the same. Such a situation is referred to as proarrythmia (Navsk et al., 2015). To prevent the reoccurrence, the doctor has to ensure that they follow-up with their patient. As such, the patient is required to visit the hospital twice in a week for checkup on their progress as well as the current heart to ensure that the heart rate is normal within the range of 50 to 100 beats per minute. The doctor is also obliged to ensure that the drug therapy is relatively effective in managing the frequency as well as the duration of the atrial fibrillation episodes. Furthermore, the follow-up phase plays a crucial role to the patient’s health as it could prevent the necessity for using long-term anticoagulation with warfarin for this patient. This creates a reliable platform for ensuring that the symptoms and quality of life of the patient are improved.
AlKalbani, A., & AlRawahi, N. (2019). Management of monomorphic ventricular tachycardia electrical storm in structural heart disease. Journal of the Saudi Heart Association, 31(3), 135-144.
Marrouche, N. F., Brachmann, J., Andresen, D., Siebels, J., Boersma, L., Jordaens, L., … & Schunkert, H. (2018). Catheter ablation for atrial fibrillation with heart failure. New England Journal of Medicine, 378(5), 417-427.
Navsk, R. K., Madhusudhana Babu, M., Srinivas Vaddadi, V. P. V., & Vikramvardhan, R. (2015). Association of arrythmias with acute myocardial infarction in the peri-infarction period: a prospective study. Journal of Evolution of Medical and Dental Sciences-JEMDS, 4(71), 12316-12321.
Sapp, J. L., Wells, G. A., Parkash, R., Stevenson, W. G., Blier, L., Sarrazin, J. F., … & Essebag, V. (2016). Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs. New England Journal of Medicine, 375(2), 111-121.