Atrial fibrillation clinical presentation

HPI DD is a 67-year-old woman who presents to the clinic complaining of headache, dizziness, and "buzzing in her ears." She states that her symptoms have been present for about 4 days. One week prior, the patient was discharged from the hospital for atrial fibrillation Rate control was achieved and she was converted to normal sinus rhythm (NSR). She was placed on a new antiarrhythmic medication to prevent further episodes of AF. PMH Episodic AF, cirrhosis,... 

Antithrombotic therapy is used in myriad CV diseases such as atrial fibrillation, heart failure, valve replacement, peripheral vascular disease, and stroke. This presents an ideal setting for a pharmacist-managed antithrombosis clinic. Today, many institutions have antithrombosis clinics managed by clinical pharmacists this trend continues to grow. 

Frequently, especially in the elderly, a paroxysmal arrhythmia crisis, especially atrial fibrillation, may cause chest pain, which may have anginal characteristics and may be of long duration, in relation with the duration of the arrhythmia. In this case the possibility to be confused with ACS is high. Often, no concurrent coronary atherosclerosis is present, and basically, the impairment of diastolic properties due to the tachycardia may explain the clinical picture. In spite of the presence of severe symptoms, the lack of enzyme-level changes, in the presence of a long-duration thoracic pain and tachyarrhythmia, leads one to suspect that this is not a classical ACS, but rather pain of anginal characteristics and usually not due to ischaemia but to haemodynamic origin. 

Cardiovascular Essential hypertension and electrocardiographic changes are present (ST-segment depression or flattening, T-wave inversion, and U-wave elevation). Clinical arrhythmias include heart block, atrial flutter, paroxysmal atrial tachycardia, ventricular fibrillation, and digitalis-induced arrhythmias. 

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