Physician's Assistant

Custom Fri 27 June 2025 14:50

Last Modified: 283 days ago

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PTWR
Dr Tuffnell-Barrett

CLINICAL PRESENTATION:
Patient presents with atrial flutter identified on ECG, symptomatic for over one month. Initially noticed palpitations over a 3-week period with increasing frequency, particularly when lying down, which prompted GP visit. Since starting bisoprolol, patient reports significant improvement in flutter sensation, though occasional episodes persist.

- Ankle swelling (developed after increasing bisoprolol to 5mg)
- Intermittent palpitations
- Heart rate 146 bpm at recent GP check despite feeling well subjectively

- Ex-smoker (15 years)
- Minimal alcohol consumption
- Avoids caffeine, occasional tea
- Night shift worker
- No family history of cardiac arrhythmias

ASSESSMENT:
Atrial flutter with evidence of heart failure secondary to tachycardia. Patient experiencing medication-related side effects (ankle swelling from beta-blocker). Background sarcoidosis stable.

MANAGEMENT PLAN:
1. Hospital admission for cardioversion and electrophysiology assessment
2. Review current medication regime given low blood pressure and side effects
3. Consider amiodarone vs alternative rate control
4. Electrophysiology mapping with view to potential ablation
5. Blood pressure monitoring during admission

The patient is agreeable to hospital admission for definitive management.

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Custom Fri 27 June 2025 14:50

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