Mrs M's Uncontrolled Hypertension

Patient Overview:

Mrs M is a 78 year old female who lives at home with her husband. She has never smoked and has reduced her alcohol consumption due to her health conditions. Mrs M eats a well-balanced diet with small meals throughout the day and exercises by walking 3 times a week for 30 minutes. She manages her own medications and uses weekly pill boxes and timers creating a strict routine to remind her when to take her medications. Mrs M doesn’t have any difficulties with her medications such as being able to read and understand labels or problems opening boxes. She is very mobile and is still able to drive herself around and doesn’t use any mobility aids. Mrs M volunteers at St Vincent de Paul Society once a week and loves catching up

There are many risk factors and comorbidities that can contribute to AF but Mrs M’s main risk factor was her uncontrolled hypertension.6 When treating AF, there are 2 main options which are followed by the “Therapeutic Guidelines” with rhythm control and cardioversion or ventricular rate control; nonetheless whichever method is chosen is dependent on the risk factors of the patient.2 Rate control uses medication that help slow down the ventricular rate and heartbeat.2,7 Medications used in rate control are β-blockers and calcium channel blockers; however Digoxin is still used in older patients.2 Digoxin is good for patients with a combination of heart failure and AF, however caution needs to be taken due to the high toxicity risk.2 Rhythm control’s objective is to convert the AF back to normal sinus rhythm using either anti-arrhythmic medications or cardioversion with electrical currents.2,7 Medications for rhythm control are Amiodarone or Flecainide, given either orally or intravenous depending on how quickly the patient needs to be converted back to standard sinus rhythm.2 Rhythm control can also be done through cardioversion with a DC shock which converts the heart back to normal sinus rhythm.2 Once rhythm control is reached through either option, maintenance therapy is required in these patients and therefore will be placed on Flecainide, Sotalol or

This option is used if other treatments aren’t tolerated by the patient.3, 11

An artificial pacemaker may be inserted which will take over the control of the heart therefore stopping AF’s from being uncontrolled.3, 12

Other oral anticoagulants have recently been released to market with Rivaroxaban and Apixaban, showing similar effects as Warfarin for stroke prevention.6 They have a quick onset of action, no need for monitoring and less food/drug interactions compared with Warfarin.6

Monitoring:

Monitoring is essential for diagnosis of AF. An electrocardiogram (ECG) is the first step conducted and can detect any sinus rhythm problems.13 ECG monitoring is continued throughout the patient’s life to monitor AF changes.13 The intensity of monitoring is dependent on each person and any complications they have. ECG is also used in patients who are being electrically cardio-converted and for patients taking Sotalol, as QT prolongation is a major