From the Guidelines
This 73-year-old male with a newly discovered irregular heartbeat should be promptly referred to a primary care physician or cardiologist for evaluation, as the irregular heartbeat could indicate atrial fibrillation, which is common in older adults and increases stroke risk. The patient needs an electrocardiogram (ECG) to confirm the diagnosis and assess heart rate, as emphasized in the guidelines for the management of patients with supraventricular arrhythmias 1. If atrial fibrillation is confirmed, treatment typically includes anticoagulation therapy such as apixaban (Eliquis) 5mg twice daily or warfarin with a target INR of 2-3 to prevent stroke, as well as rate control medications like metoprolol 25-100mg twice daily or diltiazem 120-360mg daily, as suggested by the guidelines for the management of patients with atrial fibrillation 1.
Some key points to consider in the evaluation and management of this patient include:
- A thorough clinical history and physical examination to characterize the pattern of the arrhythmia and identify any underlying heart disease or other reversible conditions 1
- An electrocardiogram to verify the diagnosis of atrial fibrillation and assess heart rate, as well as to identify any other abnormalities such as left ventricular hypertrophy or preexcitation 1
- A chest radiograph to evaluate the lung parenchyma and pulmonary vasculature, if clinical findings suggest an abnormality 1
- An echocardiogram to identify valvular heart disease, left and right atrial size, and left ventricular function, as well as to assess for peak RV pressure and left ventricular hypertrophy 1
- Blood tests of thyroid function, particularly if the ventricular rate is difficult to control or if atrial fibrillation recurs unexpectedly after cardioversion 1
The patient should monitor his pulse daily, report symptoms like dizziness, shortness of breath, chest pain, or palpitations, and seek emergency care if these occur. Home health should check vital signs, including pulse regularity and blood pressure, at each visit. Atrial fibrillation results from disorganized electrical signals in the atria causing irregular contractions, and without proper management, it increases stroke risk five-fold due to blood pooling and clot formation in the atria.
From the FDA Drug Label
Thyroid Abnormalities Amiodarone inhibits peripheral conversion of thyroxine (T 4) to triiodothyronine (T 3) and may cause increased thyroxine levels, decreased T 3 levels, and increased levels of inactive reverse T 3 (rT 3) in clinically euthyroid patients. IF ANY NEW SIGNS OF ARRHYTHMIA APPEAR, THE POSSIBILITY OF HYPERTHYROIDISM SHOULD BE CONSIDERED.
The patient's irregular heartbeat may be related to hyperthyroidism caused by amiodarone therapy.
- Key considerations:
- Monitor thyroid function prior to treatment and periodically thereafter, particularly in elderly patients.
- Hypothyroidism and hyperthyroidism are potential side effects of amiodarone.
- Hyperthyroidism usually poses a greater hazard to the patient than hypothyroidism due to the possibility of thyrotoxicosis and/or arrhythmia breakthrough or aggravation.
- If new signs of arrhythmia appear, consider the possibility of hyperthyroidism 2.
From the Research
Irregular Heartbeat Diagnosis
- The 73-year-old male patient has been found to have an irregular heartbeat on home health assessment, which may indicate a condition such as atrial fibrillation.
- Atrial fibrillation is a type of irregular heartbeat that can increase the risk of cardiac thromboembolism and coronary thrombotic complications 3.
Treatment Options
- For patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI), a non-vitamin K antagonist oral anticoagulant is recommended as the oral anticoagulation of choice 3.
- Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor should be given to all patients during the peri-PCI period, after which the default strategy is to stop aspirin and continue treatment with a P2Y12 inhibitor in combination with a non-vitamin K antagonist oral anticoagulant 3.
- In patients at increased thrombotic risk who have an acceptable risk of bleeding, it is reasonable to continue aspirin for up to 1 month 3.
Unrelated Studies
- There is a study on the operative treatment of fractures of the sternum, but it is not relevant to the diagnosis and treatment of irregular heartbeat 4.