A Case Study of Atrial Fibrillation
Case Study A 70-year-old hypertensive, diabetic male was rushed to the outpatient facility with a history of chest congestion, breathing difficulty, and chest pain. The patient was reluctant to get admitted as he had already spent two weeks in hospital due to COVID-19. He was also under home isolation with six litres of oxygen support. In light of this hesitation, the doctor took the decision to put the patient on Vigo Multi-Vital Monitoring for continuous, remote monitoring at home.
Findings
- Presented a continuous rise in respiratory rate
- Electrocardiogram (ECG) showed Atrial Fibrillation detection on day 3 Based on the clinical observations,
The patient was shifted immediately to an intensive care unit for the management of both pulmonary and cardiac conditions. Heparin was administered with electrical cardioversion. Staying connected with the doctor through remote home monitoring through Vigo multi-vital monitoring led to timely intervention that saved the patient’s life.
Pneumonia – A Probable Trigger for Atrial Fibrillation
Occurrence of Atrial Fibrillation in Pneumonia
The new onset of atrial fibrillation requires a trigger acting on a vulnerable substrate. These triggers include acute conditions such as alcohol intoxication, myocardial infarction, and pulmonary embolism. Pneumonia may act as a trigger causing the new onset of atrial fibrillation in elderly patients. Few studies report that pneumonia can trigger the new onset of AF even before it causes sepsis and acute respiratory failure. The pathophysiological mechanism could be cytokine-mediated vasoconstriction creating ischemia at the pulmonary venous atrial interface where AF often originates.
Clinical Features of Atrial Flutter Associated Pneumonia
- Chest pain during breathing or cough
- Cough that produces phlegm or mucus
- Fatigue and loss of appetite
- Fever, sweating, and chills
- Nausea, vomiting, and diarrhea
- Shortness of breath
Importance of Diagnosing Atrial Fibrillation in Severe Pneumonia Pneumonia can trigger the new onset of AF even before it causes sepsis and acute respiratory failure. Other confounding factors and comorbid conditions may worsen the situation. Atrial fibrillation in a patient with pneumonia can be a serious concern that may lead to the death of the patient if it is not diagnosed and treated on time. Diagnosis of Atrial Fibrillation Atrial fibrillation was defined by having cardiac arrhythmia with specific characteristics on ECG or dynamic ECG according to the European Society of Cardiology Guidelines as mentioned below: (1) Surface ECG shows ‘absolutely’ irregular RR intervals (2) No distinct P wave on the surface ECG; and (3) The atrial cycle length is about 200ms (300bpm). Key Takeaway Vigo multi-vital monitoring records the heart’s activity during the patient’s daily activities. In this case, the observation of a continuous increase in respiratory rate and diagnosis of atrial fibrillation through Vigo remote multi-vial monitoring helped to save the patient’s life.
References:
1. Nichols L. Pneumonia as a trigger for atrial fibrillation. J Rural Med. 2017;12(2):146-148.
2. Zhu J, Zhang X, Shi G, Yi K, Tan X. Atrial Fibrillation Is an Independent Risk Factor for Hospital-Acquired Pneumonia. PLoS One. 2015;10(7):e0131782.
3. Daltro P, Santos EN, Gasparetto TD, Ucar ME, Marchiori E. Pulmonary infections. Pediatr Radiol. 2011;41(Suppl 1):S69-S82.
4. Soto-Gomez N, Anzueto A, Waterer GW, Restrepo MI, Mortensen EM. Pneumonia: an arrhythmogenic disease?. Am J Med. 2013;126(1):43-48. 5. Ruiz LA, Serrano L, España PP, et al. New-onset atrial fibrillation in patients with pneumococcal pneumonia. Impact of timing and duration on short- and medium-term mortality. Journal of Infection. 2021;82(1):67-75
