Jane B. Reath is a 67 year old female with a history of congestive heart failure

Question

Jane B. Reath is a 67 year old female with a history of congestive heart failure. Mrs. Reath is an ex-smoker and only recently has decided to commit to a healthier lifestyle. Since her decision, she is conscientious about her diet and exercise and her ultimate goal is to discontinue taking her cardiac medications which include Digoxin and Lasix; she believes that if she can maintain this healthy lifestyle her body will no longer require therapeutic intervention. Recently though, Mrs. Reath has been noticing an increase in shortness of breath when engaging in simple tasks and also has noticed some "heart skipping." Because of this, she decides to visit her doctor.
Assume you are Mrs. Reath’s doctor. Here are your physical assessments and findings:
Her chest X-ray shows pleural effusion in the right lower lobe. Her labs reveal normal Na+, K+ and BUN, and Creatinine levels.
She is alert and oriented, exhibiting crackles in the lungs bilaterally. Bowel movement is normal and her urine is clear and unremarkable. She exhibits a normal heart rate and temperature, but has a blood pressure of 156/94 and her weight has increased 15lbs since her last visit one month ago.

Mrs. Reath's ECG rhythm strip can be seen in the link below:

http://i64.tinypic.com/2iiiihc.jpg

a) Identify what dysrythmia Mrs. Reath has from the ECG strip. Explain your reasoning.

b) What might be an appropriate treatment for Mrs. Reath from the following: Intravenous (IV) Digoxin and Lasix, defibrillation, temporary pacing, magnesium sulfate. (Please provide your rationale for your selected treatment choice.)

c) What 3 specific findings would directly account for Mrs. Reath’s shortness of breath?

d) The PR interval in the dysrythmia is: 1. Normal, 2. Prolonged, 3. Shortened, or 4. Not measureable? (Please select only one and explain your choice to receive full credit.)

Explanation / Answer

answers:

a) as per ecg strip and the symptoms stated as shortness of breath and heart skipping, it shows that the patient is having atrial flutter dysrythmia. as in this type the p waves is not observable and flutter waves are present.

b) medication will be digoxin and lasix as dysrythmia requires heart medication and due to pleural effusion diuretics should be prescribed. defibrillation and magnesium sulphate

c) 3 finding involves ecg strip which show dysrythmia, x ray of chest show pleural effusion and increased blood pressure.

d) pr interval in the dysrythmia show not measurable as the rythm of heart show the irregular, p waves are not obsevable qrs segment shows the normal pattern. as p waves represent the atria contracting by pumping blood into ventricles, but here in atrial flutter the atria beats too quickly so the waves cannot be observed properly and pr interval is not measurable.

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