Dysrhythmias
75 year-old female admitted to the telemetry unit with a diagnosis of atrial fibrillation. She is
alert, anxious and is complaining of dizziness, palpitations, shortness of air, and mild chest
pressure. BP 100/70, HR 152 irregular, RR 32. Electrocardiogram shows atrial fibrillation. Breath
sounds with bibasilar crackles.
She reports a history of hypothyroidism, and hypertension, no history of atrial fibrillation. Home
medications are levothyroxine 0.05mg daily and enalapril 5 mg BID.
Medication orders: discontinue enalapril, Digoxin 0.25mg PO daily, Diltiazem 60mg Po every 8 hours,
Warfarin 5mg PO daily
1. What is the immediate goal of the antidysrhythmic drug therapy for her? Why?
Immediate goal is to gain control of the heart rate. The digoxin and diltiazem are used to lower
heart rate. The atrial pacemaker cells are firing and competing against one another at such a
rapid rate, the atria can only quiver instead of beating or squeezing normally. Without a normal
atrial contraction, the heart rate can lose about 30% of its CO. The decrease in CO can cause
significant symptoms for some patients, such as syncope, palpitations, and SOB.
2. What nonpharmacologic therapy may be used to treat the
dysrhythmia? Electrical cardioversion
3. Identify the class of each medication ordered and explain the rationale for each.
Digoxin belongs to the class of medication called digitalis glycosides. It is used to control
the rhythm and rate of heart beat.
Diltiazem is a calcium channel blocker. Diltiazem works by relaxing blood vessels and
increasing the supply of blood and oxygen to the heart acting as a blood pressure
medication (which she has dx of but not symptomatic at present time), aids in lowering
heart rate, and taking some of the workload off of the heart.
Warfarin is an anticoagulation medication. This is used to prevent clot formation and
stroke.
She is also on a home med levothyroxine for hypothyroidism. If not taken consistently or
at a correct dose can cause anxiety symptoms and heart compilations.
75 year-old female admitted to the telemetry unit with a diagnosis of atrial fibrillation. She is
alert, anxious and is complaining of dizziness, palpitations, shortness of air, and mild chest
pressure. BP 100/70, HR 152 irregular, RR 32. Electrocardiogram shows atrial fibrillation. Breath
sounds with bibasilar crackles.
She reports a history of hypothyroidism, and hypertension, no history of atrial fibrillation. Home
medications are levothyroxine 0.05mg daily and enalapril 5 mg BID.
Medication orders: discontinue enalapril, Digoxin 0.25mg PO daily, Diltiazem 60mg Po every 8 hours,
Warfarin 5mg PO daily
1. What is the immediate goal of the antidysrhythmic drug therapy for her? Why?
Immediate goal is to gain control of the heart rate. The digoxin and diltiazem are used to lower
heart rate. The atrial pacemaker cells are firing and competing against one another at such a
rapid rate, the atria can only quiver instead of beating or squeezing normally. Without a normal
atrial contraction, the heart rate can lose about 30% of its CO. The decrease in CO can cause
significant symptoms for some patients, such as syncope, palpitations, and SOB.
2. What nonpharmacologic therapy may be used to treat the
dysrhythmia? Electrical cardioversion
3. Identify the class of each medication ordered and explain the rationale for each.
Digoxin belongs to the class of medication called digitalis glycosides. It is used to control
the rhythm and rate of heart beat.
Diltiazem is a calcium channel blocker. Diltiazem works by relaxing blood vessels and
increasing the supply of blood and oxygen to the heart acting as a blood pressure
medication (which she has dx of but not symptomatic at present time), aids in lowering
heart rate, and taking some of the workload off of the heart.
Warfarin is an anticoagulation medication. This is used to prevent clot formation and
stroke.
She is also on a home med levothyroxine for hypothyroidism. If not taken consistently or
at a correct dose can cause anxiety symptoms and heart compilations.
