How to manage atrial fibrillation in an old woman?

Question

Hi doctor,

My mother has been diagnosed with atrial fibrillation, and her heart has been out of rhythm for about four months. She has been retaining fluids and is currently in the hospital. The doctor did a cardioversion, and the heart went back into rhythm briefly. However, it did not work as well as I had hoped. The doctor advised that a pacemaker will not work in her case, because one side of her heart is better than the other. She is currently receiving Lasix. Also, the doctor drained about a liter of fluid with a needle. She has sleep apnea, but she has not been in strict compliance with her CPAP treatment. Currently, her blood pressure is running low. She is currently being given Amiodarone 200 mg, Metoprolol succinate 25 mg, Eliquis 5 mg (two times), Furosemide, and Potassium chloride micro 10 eq, they are increasing her protein intake, giving a vitamin D and vitamin C. She is also taking Famotidine and Nitrofurantoin macro 50 mg. If the cardioversion does not work and a pacemaker is not an option, are there any other alternatives to get her feeling better? She complains of nausea and fullness in the chest. The doctor advises eating more, specifically more protein. She is currently in the ICU and showing improvement. She was admitted to the hospital four years back for congestive heart failure due to untreated sleep apnea. She was in compliance with CPAP until last year. She was in hospital with flu and Covid towards the end of the last year. She is currently on treatment for pneumonia.

Please help.

Thank you.

Answer 1

Hi,

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I feel sad for your mother. May God give her a speedy recovery.

She has atrial fibrillation (an irregular, often rapid heart rate that can lead to blood clots in the heart), which can be managed with medicines. Most likely, she also has heart failure. Those with heart failure are at increased risk of pneumonia (an infection that inflames air sacs in the lungs, which may fill with fluid). Currently, acute issues like chest infection and fluid retention should be treated. Once it is controlled, then atrial fibrillation and heart failure medicines can be re-adjusted according to the response.

If her blood pressure is low, it could be due to sepsis (a life-threatening complication of an infection), or due to heart failure. The treatment depends upon the cause. In both cases, medicines that lower blood pressure like Metoprolol (beta-blocker) should be stopped.

Please share her ECG (electrocardiogram), echocardiography, chest X-ray, and blood reports, so that I can guide you accordingly.

I hope that you get your answer.

Please let me know if you want some help.

Thank you.

Answer 2

Hi,

Glad to have you back!

I am here to help you get the best medical advice.

If she has pneumonia (an infection that inflames air sacs in the lungs, which may fill with fluid) and pleural effusion (a buildup of fluid between the tissues that line the lungs and the chest), I suggest her sputum, blood and fluid should be sent for culture to see which antibiotics are effective. As her oxygen is low, it looks like her lungs are compromised due to the infection or fluid. If carbon dioxide is also high, it means she is having type 2 respiratory failure (which occurs when the respiratory system cannot sufficiently remove carbon dioxide from the body), which occurs in severe cases of pneumonia.

Treatment is BIPAP (bilevel positive airway pressure) as the first step, but if there is no improvement, then a ventilator is the final option. It will support her lungs for some days, during which her infection is treated. Once the infection subsides, then she can be weaned off from the ventilator.

It would be better if I could see her chest X-ray, ECG (electrocardiogram), echocardiogram, and other blood work to tell specifically about her condition.

I hope that you get your answer.

Please let me know if you want some help.

Thank you.