Cardiology 2.

Management of the patients with arrhythmia and heart

block.
V – 9.

I. INITIAL QUESTIONS
1. Classification of Arrhythmias?
2. Right bundle branch block. Causes? What should you do?
3. Management of patient with Atrial fibrillation?

II. CLINICAL CASE.

A 75-year-old Caucasian man presented with recurrent (three) syncope episodes, all
of them during brisk walking. He was admitted, carrying soft tissue facial injuries.
He reported a history of arterial hypertension (on therapy with perindopril+ thiazide)
and he did not complain of any symptoms, preceding the onset of episodes.

Clinical examination findings were trivial (blood pressure=140/85mm Hg, no

orthostatic hypotension). Baseline 12-lead ECG showed sinus rhythm (70 b.p.m.)
with normal atrioventricular (AV) conduction . Chest radiography and routine
laboratory investigations were within normal range. The 2D echocardiogram
disclosed aortic valve sclerosis, with normal systolic ventricular function. The carotid
sinus massage was negative. The 24-hour ambulatory Holter monitoring -with the
patient being completely asymptomatic- registered neither irregular heart rhythm nor
AV conduction disturbances.
 1. What is the most appropriate next investigation given the clinical
presentation?
2. What is the most likely diagnosis?

III. INTERPRET THE RESULT OF THE INVESTIGATION

 1. What do you see here?
2. What is the patient's most likely diagnosis?

IV. PRESCRIPTIONS
1. Prescribe Propafenon to patient with atrial fibrilation.
2. Prescribe Bisoprolol to patient with VT.