67 year old female with palpitations.

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 

 Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

 This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment .


A 67 year old female came to the casualty with 
C/o palpitations on 27/12/2021.

HOPI:- 

Patient was apparently asymptomatic 4 days back then she developed palpitations associated with giddiness due to which she came to the hospital.
Patient took Tab.metxl 50mg on her own.
Patient is on tab.ecosprin , tab.clopitab , tab.metxl 50mg OD.
Patient took double dose of metxl 50 mg due to palpitations.

Patient was kept under observation.
Resting Heart rate was 27bpm.
Inj.atropine 6mg Stat was given,  then her heart rate increased to 70bpm.
After walking for about 20 min her heart rate was 60 bpm.
Her ECG showed sinus bradycardia , occasional Vpc's .
2d echo was done- no RWMA, EF-55%, good LV function.
Patient was advised to stop metxl 50 mg in the view of bradycardia.
Vitals at admission:-
Temperature- afebrile
BP:- 140/90  mmhg.
Pr- 140bpm
Rr:- 20cpm.
Metoprolol 2mg inj. Was given and kept under observation.

Past history:-she is a Known case of atrial fibrillation since 9 years.
PTCA was done 4 years back.
No history of Diabetes , TB, epilepsy.

General examination:- 
Patient is conscious, coherent , cooperative, well oriented to time, place and person.
Vitals:- 
Bp:- 110/70mmhg.
Spo2:-98%
RR:- 17cpm.
Temperature :- Afebrile.


Systemic examination:-

Cvs:- s1,s2 heard.(+)
Respiratory system:-BAE present
P/A :-soft and non tender.
Cns:- no focal neurological deficit.

Provisional diagnosis:- 

Atrial fibrillation with fast ventricular rate.

Treatment :- tab metxl 50mg OD.

Investigations:-













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