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Atrial Fibrillation as A Complication of Congestive Heart Failure in Elderly Patient: A
Case Report
Hizkia1, Michael Jonathan1, Levina Tri Ratana1, Arif Ridha1,
Arinta Setyasari2, Prihati Pujowaskito3
General Practitioner at Dustira Hospital, 2Cardiologist at Dustira Hospital,
Chairman of Cardiology Department at Dustira Hospital
Heart failure (HF) is a clinical syndrome that present when the heart is unable to pump blood
forward at a sufficient rate to meet the metabolic demands of the body. HF results in a
clinical syndrome of dyspnea, fatigue, peripheral edema and rales. In CHF patient often
occurs ventricular remodeling that leads to induce complications, such as AF. Most patients
(more than 50%) with CHF are elderly because of degenerative changes in cardiac structure
and function.
A 75 year- old man with chief complaint was dyspnea on effort, orthopnea, and paroxysmal
nocturnal dyspnea since ± 10 days before hospitalized in daily physical activity such as take a
bath. Physical examination showed blood pressure 150/90 mmHg, heart rate ± 120 bpm
irregularly irregular, respiration 32 times/ min, body temperature 37.3oC, oxygen saturation
93 %, increase JVP, rales at the inferior lungs, and peripheral edema. ECG recording showed
rate ± 180 bpm irregularly irregular and ventricular extra systole (VES). He was diagnosed as
Congestive Heart Failure (CHF) NYHA Functional Class III and Atrial Fibrillation (AF) with
Rapid Ventricular Response with VES. He was treated with furosemide, candesartan,
bisoprolol, and warfarin. On the second day of hospitalization, his complaints decreased and
ECG showed AF with moderate ventricular response without VES.
AF is often associated with right or left atrial enlargement including heart failure and
hypertension. When the rapid ventricular rate occurs in AF, it may compromise cardiac
output, resulting in hypotension and pulmonary congestion. The goals of therapy in patients
with heart failure are elimination of the acute precipitating cause, management of heart
failure symptoms, and modulation of the neurohormonal response to prevent adverse
ventricular remodeling in order to prevent/ eliminate its complication. AF is also an important
cause of stroke.
Key Word
Atrial Fibrillation Congestive Heart Failure, Ventricular Remodeling