Morning Report

Morning Report: A-Fib with RVR

Resident Presenter: Terrence Horan

Summary: 69 year old female with A-fib and RVR, hypotension with acute renal failure and urosepsis, but well appearing and wanting to go home.  Discuss the stabilization of blood pressure with IV fluids prior to rate control medications. Importance of a thorough workup to look for underlying causes of a-fib and hypotension rather than just focusing on rate control. Understand that rate control interventions were not without adverse effects.

Learning Points:

  1. Importance of looking for underlying causes of A-fib with RVR and in this case hypotension
  2. Understanding the need for a thorough workup to look for underlying causes and not to get anchored on one theory
  3. Knowing the adverse effects of rate control medications and when it is necessary to move to electrical conversion.

EBM Article: Scheuermeyer, F. Emergency Department Patients with Atrial Fibrillation or Flutter and an acute underlying medical illness may not benefit from attempts to control rate or rhythm. Annals of Emergency Medicine May 2015.

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