Cardiac Arrhythmia in 83 Year Old Woman: Mrs. Clark

Running Head: Case Study-Mrs.Clark
Assessment 1
Case Study- Mrs Clark
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Case Study- Mrs. Clark
2
Mrs Clark is 83 year old women admitted in HDU for the last 2 days for partial
gastrectomy for Cardiac Arrhythmia (CA). She has a history of COPD.
1. Cardiac Arrhythmia
The Cardiac Rhythm of Mrs. Clark shows Ventricular Tachycardia (VT) with left
bundle morphology and irregular cardiac rate of nearly 110 beats per minute.
Ventricular Tachycardia is a kind of cardiac arrhythmia with abnormal QRS complex
originating in the ventricle at a faster rate of more than 110 breaths per Minute. ECG
of Clark shows negative QRS complex. The R wave is changing from narrow to wide
after 5 normal QRS waves, intermittently. P wave disappears during the 5-6 waves
of negative QRS phase. The ECG shows 5 negative or abnormal heart beats in a
row, after that the normal heart beats resume back. PR interval is normal which
shows, normally slow conduction through atrio-ventricular node. The delay makes
the atria to fill up the ventricles prior to commencement of ventricular contraction.
The QRS complex in the V2 phase, or deformed part of the ECG shows a large
negative Q wave which is followed by a small positive r wave.
The increase in general automaticity initiated by late or early after depolarisations
and the re-entry activity results into ventricular tachycardia. The cardiac muscles in
deflected area are taking more time to repolarise which may be due to damaged
cardiac tissue or disturbance in electrical conduction or injured myocardial infarction.
In the middle part of the ECG strip, the changes due to intermittent ventricular

Case Study- Mrs. Clark
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repolarisation are masked by the secondary T waves generated by disturbance in
conduction and they become apparent after the normal repolarisation resumes after
5 breaths.
The potential reasons for the Ventricular Tachycardia to occur are a history of
COPD, old age of 83 years and recent surgical procedure of partial gastrectomy for
Cardiac Arrhythmia (CA) which weakens the cardiac muscles. A history of COPD
increases the risk of Cardiac Arrhythmia (Rusinowicz, Zielonka & Zycinska , 2017). It
is a kind of abnormal cardiac rhythm that occurs when the ventricles beat at faster
rate to pump blood and the body does not receive sufficient oxygenated blood. The
condition mainly occurs when the cardiac muscles are damaged and the scar tissue
generates abnormal electrical stimulus propagating towards the ventricles. Initially,
when Ventricular Tachycardia lasts for shorter time, it may show no evident
symptoms except palpitation (Foth, Gangwani & Alvey, 2020). However, when the
condition lasts more than 30 seconds may develop other conditions like SOB, chest
pain, dizziness, fainting etc. Also age associated morbidity and cardiovascular
ageing also increases the ventricular pressure especially during the contraction and
increases the risk of Ventricular Tachycardia. Ventricular myocardium undergoes
structural and electrical remodelling with age which plays significant role in initiation
of Ventricular Tachycardia.
Three treatment options for a patient in Ventricular Tachycardia involve
Radiofrequency Ablation, Implantable Cardioverter Defibrillator (ICD) and

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Medications. Radiofrequency Ablation involves minimally invasive procedure to
damage the cells which develop ventricular tachycardia (Dukkipati, Choudry, Koruth
& Miller, 2017). The procedure is less effective when the patient has a history of
structural cardiac illness. Implantable Cardioverter Defibrillator involves a procedure
to implant a device which provides electrical impulse to the cardiac muscles for
resetting the irregular or abnormal heart beat. The device continuously monitors the
heart beat, detects any abnormal heart rate, and delivers precise electric shocks for
restoring normal cardiac rhythm. Multiple antiarrhythmic medicines can be
administered to the patient for curing the VT (Chiale, Etcheverry & Pastori, 2014).
The medications include Amiodarone, Propafenone, Flecainide and Sotolol etc.
COPD and VT are independently associated (Konecny, 2018). The patients of
COPD are at high risk of mortality due to VT. In emergency conditions, electrical
defibrillation, CPR and IV medicines may also be given to reduce the heart rate.
Overall the management and treatment of Tachycardia involves managing and
controlling any health condition that causes abnormal heart rhythm.
2. Pathophysiology and treatment