In this paper, a case study of an older patient diagnosed with Left Bundle Branch Block (LBBB) and fast Atrial Fibrillation (AF) after a Total Knee Replacement (TKR) will be discussed, including the assessment, pathophysiology, treatment and management.
Atrial fibrillation (AF) may result after a Total Knee Replacement (TKR) especially in older adults as a consequence of hypercoagulability and proinflammatory states associated with anaesthesia and surgical trauma, hyperadrenergic state related to perioperative stress, hypoxia, and hypovolemia leading to increased myocardial oxygen demand. Specifically, tachycardia as the heart’s compensatory mechanism to supply the systemic circulation leads to subsequent arrhythmias.
In addition to AF, Left Bundle Branch Block (LBBB) also occurs as an associated condition in older adults above 75 years old due to vascular incompetency and stasis. Usually, people with AF experience palpitations, dyspnea, syncope, fatigue and other cardiovascular and pulmonary manifestations. However, the most important danger posed by LBBB and AF is the hemodynamic stagnation which promotes the thrombus formation and decreased cardiac output.
The patient is an 83-year-old gentleman who had undergone a total knee replacement on August 16, 2011. His past medical history was significant for hypertension and arthritis. He reported to have past medical history of atrial fibrillation. ...
He reported to have past medical history of atrial fibrillation. On the other hand, he stated independence on performing most of his activities of daily living including household chores without difficulties. He claimed not having episodes of orthopnea or paroxysmal nocturnal dyspnea. He was able to walk half a mile before becoming short of breath. Impaired with worsening arthritis, the involved knee caused immobility problems and extremely debilitating pain that occurred usually after an exertion. In a short walk, the patient’s knee was traumatically injured that prompted surgical intervention. The patient qualified for the operation after the panel of pre operative assessment was carried out. However, the patient manifested shortness of breath and chest pain two days after the operation. He was then transferred to an orthopaedic centre to manage the acuteness of the symptoms. Also, the patient was connected to a cardiac monitor and an electrocardiographic reading was taken. He was initially given Bisoprolol 2.5 mg but the condition showed no improvement. At that same night, the patient was transferred to Critical Care Unit of Royal Sussex County Hospital where blood studies were run through. His final diagnosis is Left Bundle Branch Block (LBBB) and fast Atrial Fibrillation (AF). Assessment Cardiac complications resulting from surgery are the result of an intricate and dynamic relationship among patient- related risk factors including the patient’s functional capacity, procedure-related risk factors, and the circumstances surrounding the operation. Preoperative patient evaluation begins with obtaining a detailed history and physical examination (Fleisher et al. 165). After the total knee