Jessica went to her physician complaining of fatigue and mentioned that she had
ID: 3514778 • Letter: J
Question
Jessica went to her physician complaining of fatigue and mentioned that she had been experiencing heavier menstruations over the past several months. He mentioned that she had mitral valve prolapse, but didn't think that was the cause of her fatigue and advised her take more iron in her diet while they waited for the blood test results. However, a subsequent ECG revealed that she had atrial fibrillation, which he said might also explain her fatigue. The physician prescribed a drug called rivaroxaban, and told Jessica that she should perhaps exercise more moderately and that she should definitely stop smoking.
Some of the new terms and concepts you will encounter include:
Anemia, blood clotting factors, heart valves and heart sounds
Electrocardiogram and heart arrhythmias
Atherosclerosis, thrombosis, and cardiovascular diseases
essica experienced heavy menstruations and fatigue, and her blood was tested.
How might heavy menstruation and fatigue be related?
How might a blood test help to diagnose the cause of Jessica's fatigue?
Jessica was prescribed rivaroxaban, a drug that inactivates factor X.
What is the action of factor X?
Would the drug interfere with the intrinsic or extrinsic clotting pathway?
Jessica was told that she has a mitral valve prolapse.
What is a mitral valve prolapse, and where on the chest might it best be heard?
Is it likely that Jessica's fatigue is due to her mitral valve prolapse?
Jessica was told that she has atrial fibrillation and experienced fatigue, and the physician prescribed rivaroxaban.
How might atrial fibrillation explain Jessica's fatigue?
What is the major danger of atrial fibrillation, and how does rivaroxaban help?
The physician told Jessica that she had atrial fibrillation.
What is atrial fibrillation, and how does it appear on an ECG?
What is the major danger of atrial fibrillation, and how did Jessica's physician address this?
Explanation / Answer
1. Heavy menstruation lead to excessive blood loss thus she may have developed anemia which led to fatigue.
2. The blood test would reveal whether she has anemia or not therefore cause of fatigue can be found.
3. Activated factor X or Xa cleaves prothrombin into Thrombin (with factor V) thus help in coagulation.
4. Both extrensic and intrensic pathway as Factors X is common in both.
5. MVP is incomplete or misaliged clouser of mitral valve which cause it to bulge into left atrium. The murmur is heard in the mitral area (on left side in 5 intercostal space 9 cm away from mid sternal line).
6. Yes. MVP may led to Regurgitation of blood int LA thus cardiac output .ay decrease and over many years it may lead to CHF which cause fatigue.
7. In atrial fibrillation there rapid and irregular contraction of atrium therefore blood flow into ventricle may be compromised. Thus body is deprived of oxygen rich blood which lead to fatigue.
8. AF patient can develop thrombo - embolism (dur to stasis of blood in atria). Riva is anticoagulant which reduces chances of development of thrombus. AF can lead to Heart faliure also.
9. Atrial fibrillation is incomplete and irregular electrical activity in atrium. ECG changes - No P wave, irregularly irregular rythm, absence of isoelectric base line.
10. Explained in answer 8.
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