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Muna1:
70 year man is admitted with new onset atrial fibrillation with heart rate 120/minute and Bp 100\70mmhg.after admission he develops moderate lower abdominal pain and diarrhoea with dark read blood.
what is the diagnosis and the treatment?

Admin:
A: Probably this patient is suffering from ischemic colitis (colonic ischemia).
The colon receives blood supply from both the superior and inferior mesenteric arteries. the blood supply from these major arteries     overlap, with abundant collateral circulation. however there are weak points, or "watershed" areas which are vulnurable to be blocked by embolisms thus causing occlusive colonic ischemia.

The colon receives between 10% and 35% of the total cardiac output. if blood flow to the colon drops by more than about 50%, ischemia will develop!!!, because the arteries feeding the colon are very sensitive to vasoconstrictors.

Symptoms of ischemic colitis vary depending on the severity of the ischemia. the most common early signs of ischemic colitis include abdominal pain (often left-sided), with mild to moderate amounts of rectal bleeding.

So the cardinal symptoms & signs of such a case are:


* Abdominal pain (78%)
* Lower digestive bleeding (62%)
* Diarrhea (38%)
* Fever > 38C (34%) - not mentioned in our case
B: Anticoagulants pop-up to the front, this patient should be given IV heparin to dissolve that emboli and prevent other clots.
Usually when a patient with atrial fibrillation is admittend he must be put on anticoagulants, and never do cardioversion to those patients unless you give them anticoagulants, usually heparin is preferable becuase warfarin is taking long time to act.

The older form of heparin, unfractionated heparin, is usually administered via continuous intravenous infusion, and frequent blood tests (PPT, prothrombin-proconvertin test) are performed to monitor how "thin" the heparin is making the blood. Some doctors use one of the newer heparin preparations, low-molecular-weight heparin, to thin the blood.

Then you may begin to give other medications like beta-blockers, calcium-chanel blockers and digoxin. then at last cardioversion with long-term treatment with warfarin.
Dr.Mahdi

Muna1:
admin really you are very good doctor
.this is good answer  ,you impres me  8)

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