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Medical Emergencies · patient case with 2 questions

Man in exercise clothing requesting a rapid appointment

Patient: Adult male

Chief complaint: Arrives in tennis and jogging clothes, asking to be seen quickly so he can continue his exercise routine.

Background: Atrial fibrillation, with episodes provoked by stress and by exertion.

Current findings: Currently asymptomatic and haemodynamically stable.

Question 1

Atrial fibrillation in this patient most predisposes him to which emergency?

  1. Thromboembolic stroke
  2. Hypoglycaemia
  3. Malignant hyperthermia
  4. Seizure
Show answer and explanation

Correct answer: A. Thromboembolic stroke

  • A. CORRECT. In atrial fibrillation the atria quiver rather than contract, blood stagnates in the left atrial appendage and thrombus forms. Embolisation of that thrombus to the cerebral circulation makes STROKE the defining risk — which is precisely why these patients are anticoagulated, and why their anticoagulation must be respected rather than casually interrupted for dental care.
  • B. Hypoglycaemia is unrelated.
  • C. Malignant hyperthermia is a pharmacogenetic reaction to volatile anaesthetics and succinylcholine.
  • D. Seizure is not a consequence of atrial fibrillation, although a large embolic stroke can subsequently cause seizures.

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Question 2

All of the following are appropriate management measures for this patient EXCEPT one. Which is the EXCEPTION?

  1. Using a stress-reduction protocol
  2. Routinely dispensing postoperative opioid analgesics
  3. Keeping appointments short
  4. Explaining the procedure thoroughly to reduce anxiety
Show answer and explanation

Correct answer: B. Routinely dispensing postoperative opioid analgesics

  • A. A stress-reduction protocol is exactly what a stress-triggered arrhythmia calls for.
  • B. CORRECT — this is the EXCEPTION. Routine opioid prescribing is not a stress-reduction measure and is not indicated. Opioids carry dependence, respiratory depression and interaction risks, and in an anticoagulated cardiac patient NSAID choices also require care. Analgesia should be tailored to the procedure actually performed, not dispensed reflexively.
  • C. Short appointments genuinely reduce physiological stress and are a core element of the stress-reduction protocol.
  • D. Thorough explanation reduces anxiety, which is the specific trigger for this patient's arrhythmia.

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