A 67yr old female came to casualty with c/o palpitations since evening (27/12/21)
A 67yr old female came to casualty with c/o palpitations since evening (27/12/21)
HOPI
Patient was apparently asymptomatic 4 days back then he developed palpitations (on 25/12/21),associated with giddiness.Patient took TAB.MET XL 50 mg on her own.
Patient is on Tab.ecospirin,Tab. Clopitab,Tab. MetXL 50mg OD
Patient took double dose of Met XL due to palpitations
Patient was kept under observation
Resting Heart rate-27bpm
Inj.atropine 6mg stat was given then her
Heart rate was 70bpm
On 20 min walk her heart rate was 60bpm
Her ECG showed sinus bradycardia, occasional vpc’s
2d echo-no RWMA,EF-55%,good LV function
Past was advised to stop Tab.metxl in view of bradycardia
Since yesterday evening (27/12/21),she developed palpitations,chest thightness ,sob
Vitals at admission
Temp-afebrile
Bp-140/90mmhg
Pr-140bpm
Rr-20cpm
Inj.Metaprolol 2mg was given and was kept under observation
Past history
K/c/o atrial fibrillation since 8-9yrs
PTCA done 4yrs back
N/k/c/o DM,BA,Epilepsy,TB
General examination
Patient is conscious,coherent, cooperative
Vitals
Temp-afebrile
Bp-110/70mmhg
Pr-75bpm
Rr-17cpm
Spo2-98%on ra
Systemic examination
Cvs-S1,S2 +
Rs-BAE present
P/A-soft ,non tender
CNS-NAD
Provisional diagnosis
Atrial fibrillation with fast ventricular rate
Treatment
1.Tab.Metxl 50mg OD
Investigations
Ecg-At the time of admission
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