CLINICAL CASE

WEEK FROM
AUGUST 30 TO
SEPTEMBER 02

A PATIENT WITH Something

old, something new and
something slow?
A 79-year-old man with obesity, high blood pressure (HBP), type 2 diabetes
mellitus, ischemic heart disease, AF, chronic obstructive pulmonary disease
(COPD), and sleep apnea syndrome.sleep. Go to Primary Care consultation
forpresent dizziness with a sensation of spinning objects,especially when
he walks, that he yields at rest.He reports an increase in his usual dyspnea.
He has not presented loss of consciousness, nor chest pain,neither
vomiting nor cold sweats. perform treatmentusually with amlodipine,
repaglinide, nitroglycerin (patches), acenocoumarol, atorvastatin,atenolol,
acetylsalicylic acid, spironolactone, protamine isophane insulin,
paracetamol-tramadol andomeprazole, with good compliance.On physical
examination, the presence ofarrhythmia on cardiac auscultation, with slow,
muffled tones, without murmurs. Radial pulses are present and
symmetrical. on auscultationgeneralized hypoventilation is seen in the
lungs,without added noise. The neurological examination is rigorously
normal. He has edemawith pitting up to the knees and signs of chronic
venous insufficiency in the lower limbs. Withpulse oximeter detect a heart
rateof 30 beats per minute (bpm) and a saturation of90% oxygen.
 ABSTRACT
• Atrial fibrillation (AF) is the most common arrhythmia in clinical
practice. It is responsible for high morbidity and mortality.
• A patient with known AF, who is adequately treated, and begins to
feel dizzy, should alert the Physician. An electrocardiogram is essential
for a correct diagnosis: the presence of bradycardia in a patient with
AF.
• This clinical situation constitutes a cause for immediate hospital
referral to carry out an etiological study and appropriate treatment
given the severity of the clinical picture.
 QUESTIONS?
• 1. What do you think is the appropriate treatment for a patient with
AF?
• 2. Do you think that with an electrocardiogram we will be able to
recognize the true diagnosis of the patient with AF?
• 3. What is atrial fibrillation?
• 4. What vains are affected in atrial fibrillation?
• 5. What history did the patient have?