A patient with paroxysmal nonvalvular atrial fibrillation and a normal ejection fraction has been taking diltiazem ER (e
Posted: Tue Jul 12, 2022 1:28 pm
A patient with paroxysmal nonvalvular atrial fibrillation and anormal ejection fraction has been taking diltiazem ER (extendedrelease) 240 mg oral daily for rate control for the last 6 monthsalong with apixaban (Eliquis) 5 mg oral twice a day for strokeprophylaxis. The patient developed dizziness and palpitations. EMSwas called and brought the patient to the emergency department(ED). In the ED, the patient was noted to be in atrial fibrillationwith rapid ventricular response (RVR) with a rate of 205. BP 78/46mm Hg. You are the ED NP. Given the hemodynamic instability, youperformed synchronized cardioversion emergently. The patientconverted to sinus rhythm with 1 biphasic shock at 100 J. BPimproved to 112/63 mm Hg. Cardiology was consulted and elected tostart the patient on IV amiodarone. A 150 mg bolus was given IVover 10 minutes, followed by 1 mg/min x 6 hours, then 0.5 mg/min x18 hours.
Questions to consider:
The patient is asking why amiodarone was started. What would youtell the patient regarding the decision to use IV amiodaroneinstead of IV diltiazem?
What education will you give the patient about amiodarone?
What are some long-term adverse effects of amiodarone?
What type of follow-up will the patient need?
The patient is also asking if the apixaban can be discontinuedbecause they are in normal sinus rhythm. How would you respond?
Questions to consider:
The patient is asking why amiodarone was started. What would youtell the patient regarding the decision to use IV amiodaroneinstead of IV diltiazem?
What education will you give the patient about amiodarone?
What are some long-term adverse effects of amiodarone?
What type of follow-up will the patient need?
The patient is also asking if the apixaban can be discontinuedbecause they are in normal sinus rhythm. How would you respond?