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0:00
Hello, I'm Dr. Brian Olshansky,
Professor of Medicine
at the University
of Iowa Hospitals
in Iowa City, Iowa.
Today, I would like to discuss
the management
of atrial fibrillation,
talk about some
of the challenges
and some of the new solutions.
But to do this, I would
like to focus on a patient,
a patient that you
may see in practice,
who has atrial fibrillation.
And I would just like to say
that atrial fibrillation
is becoming
a very large problem.
It is seen in virtually
any clinical practice now
and there are many
potential issues
with regard to
its management and treatment
and there are many solutions
that are also available.
And in some instances,
these solutions necessarily
do not work together
in a way that makes perfect
sense for all clinicians.
So this adds to
the challenges of the problem.
And I think this can
be well-highlighted
in the patient that I would
like to show you.
0:59
Here I describe a 72-year-old
female with palpitations.
Her chief compliant
is debilitating fatigue,
she has dyspnea
2-3 times a day,
mostly with exercise
and walking upstairs.
Her past medical
history is significant
for hypertension and diabetes
and she takes metoprolol,
25 milligrams twice a day.
And physical examination,
her blood pressure is 144/94,
and her pulse is
120 and irregular.
Her lungs are clear
and her heart is normal.
There is an irregular pulse
but no murmur or gallop.
And the rest of her physical
examination is unremarkable.
1:38
As you can see
on her electrocardiogram,
she has atrial fibrillation
with a narrow QRS complex
and no other specific
changes except the fact
that she has
an irregular rate and it's rapid
and she has perhaps
some evidence
for left ventricular
hypertrophy.
