Mrs. Franklin is a 68-year-old woman with long-standing, persistent AF being managed
with rhythm control on dofetilide. She also has type 2 diabetes mellitus (T2DM),
hypertension, and a myocardial infarction 3 years ago.
What is her CHADS2 and CHA2DS2-VASc score? How would you interpret those scores in
deciding on treatment for Mrs. Franklin?
Correct
Answer:
CHADS2 score=2 (HTN, T2DM)
A score of greater than 2 is considered high risk for stroke.
CHA2DS2-VASc score=5 (age >65, female, HTN, T2DM, coronary artery
disease [CAD])
A score of greater than 2 is considered high risk for stroke.
Many patients are hesitant to begin anticoagulation due to the expense and
inconvenience. However, after understanding that a 4% annual risk for stroke
(if the CHA2DS2-VASc Score is 4) equates to 40% risk over 10 years, patients
are more willing to comply.
A 58-year-old male complains of a galloping heart rate and shortness of breath. Vital
signs are BP 110/74, P 156, RR 22 Oxygen sat is 96%. Continuous EKG monitoring
identifies periods of sinus tachycardia as well as episodes of atrial fibrillation. Laboratory
results for this patient show:
Hemoglobin 13.3 g/dl
Hematocrit 39%
WBC 8.7
Platelets 172,000
Sodium 140
Potassium 3.7
TSH 0.0 mIU/L
T4 3 mg/dl
T3 6.6 pg/ml
What is your working diagnosis and what two initial medications would you prescribe for
this patient?
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