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Instantly Converting Atrial Fibrillation into Sinus Rhythm by a Digital Rectal Exam on a 29-year-Old Male.

Ruan CH - Clin Med Insights Case Rep (2010)

Bottom Line: Here, we present a 29-year-old male with no cardiovascular history and a low atherosclerotic risk profile who developed AF which converted into sinus rhythm immediately after a digital rectal exam.The patient remained asymptomatic after a 3-month follow-up.This implies that the digital rectal exam can be considered as an additional attempt to convert AF to sinus rhythm in AF patients.

View Article: PubMed Central - PubMed

Affiliation: New York Hospital Medical Center of Queens/Weil Cornell Medical College Affiliated Hospital, Department of Internal Medicine, Flushing, NY, USA.

ABSTRACT
Vagal maneuvers cause increase in vagal tone, which has been shown to slow many types supraventricular tachycardia, such as atrial fibrillation (AF). However, the conversion of AF to sinus rhythm is usually not associated with vagal manuvers. Thus, AF is classically treated with medication and electrical cardioversion. Here, we present a 29-year-old male with no cardiovascular history and a low atherosclerotic risk profile who developed AF which converted into sinus rhythm immediately after a digital rectal exam. The patient remained asymptomatic after a 3-month follow-up. This implies that the digital rectal exam can be considered as an additional attempt to convert AF to sinus rhythm in AF patients.

No MeSH data available.


Related in: MedlinePlus

The telemetry strip recording of Lead II for the 29-year old male before (panels I and II) and after (panel III) the digital rectal exam.
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f2-ccrep-2010-051: The telemetry strip recording of Lead II for the 29-year old male before (panels I and II) and after (panel III) the digital rectal exam.

Mentions: The patient was found to be in rapid atrial fibrillation in the Emergency Department. Predicted onset of atrial fibrillation, based on the patient’s symptoms, is less than 48 hours. He was admitted and monitored by telemetry. Metoprolol 5 mg IV was given for rate control. A heparin drip was planned for the patient in anticipation of his undergoing cardioversion since anticoagulation is necessary prior to cardioversion to prevent development or further development of atrial thrombus and thereby preventing embolic events. However, prior to starting anticoagulation, a digital rectal exam (testing the stool for occult blood) is required to rule out a GI bleed. Before administering the rectal exam, the patient’s heart rate was 140 bpm in rapid atrial fibrillation (Fig. 2, panels I and II). After the digital rectal exam, his rhythm converted to normal sinus and the rate decreased to 80 beats per minute. (Fig. 2, panel III). The patient no longer complained of discomfort and was discharged from the hospital. In addition, the patient remained asymptomatic after a 3-month follow-up.


Instantly Converting Atrial Fibrillation into Sinus Rhythm by a Digital Rectal Exam on a 29-year-Old Male.

Ruan CH - Clin Med Insights Case Rep (2010)

The telemetry strip recording of Lead II for the 29-year old male before (panels I and II) and after (panel III) the digital rectal exam.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3046006&req=5

f2-ccrep-2010-051: The telemetry strip recording of Lead II for the 29-year old male before (panels I and II) and after (panel III) the digital rectal exam.
Mentions: The patient was found to be in rapid atrial fibrillation in the Emergency Department. Predicted onset of atrial fibrillation, based on the patient’s symptoms, is less than 48 hours. He was admitted and monitored by telemetry. Metoprolol 5 mg IV was given for rate control. A heparin drip was planned for the patient in anticipation of his undergoing cardioversion since anticoagulation is necessary prior to cardioversion to prevent development or further development of atrial thrombus and thereby preventing embolic events. However, prior to starting anticoagulation, a digital rectal exam (testing the stool for occult blood) is required to rule out a GI bleed. Before administering the rectal exam, the patient’s heart rate was 140 bpm in rapid atrial fibrillation (Fig. 2, panels I and II). After the digital rectal exam, his rhythm converted to normal sinus and the rate decreased to 80 beats per minute. (Fig. 2, panel III). The patient no longer complained of discomfort and was discharged from the hospital. In addition, the patient remained asymptomatic after a 3-month follow-up.

Bottom Line: Here, we present a 29-year-old male with no cardiovascular history and a low atherosclerotic risk profile who developed AF which converted into sinus rhythm immediately after a digital rectal exam.The patient remained asymptomatic after a 3-month follow-up.This implies that the digital rectal exam can be considered as an additional attempt to convert AF to sinus rhythm in AF patients.

View Article: PubMed Central - PubMed

Affiliation: New York Hospital Medical Center of Queens/Weil Cornell Medical College Affiliated Hospital, Department of Internal Medicine, Flushing, NY, USA.

ABSTRACT
Vagal maneuvers cause increase in vagal tone, which has been shown to slow many types supraventricular tachycardia, such as atrial fibrillation (AF). However, the conversion of AF to sinus rhythm is usually not associated with vagal manuvers. Thus, AF is classically treated with medication and electrical cardioversion. Here, we present a 29-year-old male with no cardiovascular history and a low atherosclerotic risk profile who developed AF which converted into sinus rhythm immediately after a digital rectal exam. The patient remained asymptomatic after a 3-month follow-up. This implies that the digital rectal exam can be considered as an additional attempt to convert AF to sinus rhythm in AF patients.

No MeSH data available.


Related in: MedlinePlus