Health Perceptions:
Ms. V. denies any history of heart disease in herself or in her family. She has no history of alcohol or drug use. She weighs 55 kg and is 5’5" tall. She eats a healthy diet. Ms. V states she has had several episodes of palpitations and shortness of breath over the past few months, but none this severe.

Activity-Excerise Patterns:
Ms. V. is an aerobics instructor and personal trainer for a local health club. She teaches 3 classes per day and power-walks 3 miles, 3 times per week.

Physical Exam:

Neuro - oriented to time, place, and person. Complains of dizziness when sitting or standing.
CV - exam reveals irregularly irregular pulse. Heart sounds are also irregular and difficult to distinguish.
Resp - complains of shortness of breath. Lungs are clear.
GI - unremarkable
GU - unremarkable

Labs and diagnostic tests:

Sodium 132, Potassium 3.6, BUN 7, Creatinine 1.2, Random glucose 110
EKG shows atrial fibrillation with a rate of 160 bpm.
CXR - normal

Treatment:

Ms. V. is given a dose of warfarin and successfully cardioverted with 100 joules. She is placed on anticoagulant therapy and will be seen in one week for a follow-up exam and labs.

Patient Teaching:

Patient teaching prior to discharge should include the following:

• Information about her anticoagulant therapy including the correct dosage, when to take it, signs and symptoms of an overdose, drug interactions, and the importance of keeping the follow-up appointment and labs.
• Activity recommendations post cardioversion.
• Information about lone atrial fibrillation.
• Community resources and support groups for people with lone atrial fibrillation.

and visit this site and download the patient teaching guide specific to atrial fibrillation, provided by Wausau Hospital. You will find some specific information about diagnostic tests and anticoagulant therapy.

It is important to understand when providing patient informational pamphlets that most are written for people with chronic atrial fibrillation and to point out the important areas that are specific to acute episodes of rapid atrial fibrillation.