- Atrial fibrillation with an Uncontrolled Ventricular Rate
- Normal axis
- Normal QRS complexes
- Normal ST segments
The rhythm could be interpreted as atrial flutter, particularly in lead VL. However, the flutter-like activity is variable, and the QRS complexes are completely irregular, so this is atrial fibrillation.
The ST segments are normal, with no suggestion of digoxin effect, and the ventricular rate is not controlled, so the patient is probably not taking digoxin.
What to do ?
The ventricular rate in this case is rapid, and the uncontrolled rate may be contributing to the patient’s heart failure. Her thyroid function tests should be checked, and she needs an echocardiogram to assess heart size and left ventricular function.
The heart rate needs to be controlled. Her heart failure must be treated with a diuretic and probably an angiotensin-converting enzyme inhibitor, and then a decision has to be taken regarding cardioversion.
This is unlikely to be successful unless some remediable cause of the atrial fibrillation, such as thyrotoxicosis, is detected. At this age, she will need life-long anticoagulation with warfarin, whatever her echocardiogram shows.