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. ...