Atrial Fibrilation in Young Patient: A Lesson from Serial Cases

Arif Ridha1, Levina Tri Ratana2, Hizkia2, Michael Jonatan2, Arinta Setyasari3, Prihati Pujowaskito4
1

General Practitioner at Dustira Hospital , 2Cardiology Intern at Dustira Hospital,3Cardiologist at

Dustira Hospital, 4Head of Cardiology Department at Dustira Hospital

Abstract

Atrial fibrillation is an irregular and often rapid heart rate that can increase the risk of stroke, heart
failure, and other heart-related complications.

Case report 1: a 16 year-old male came to the ER with dyspnea on exertion and palpitation since 3
days prior to admission. Paroxysmal nocturnal dyspnea and edema of extremities were also
complained. There was a history of untreated pharyngitis on childhood. ECG showed atrial fibrillation
with rapid ventricular response. Laboratory examination showed thrombocytopenia (95.000/mm 3)
with negative result of IgM and IgG anti-dengue test. Transthoracal echocardiography displayed
severe mitral stenosis with mild mitral regurgitation. The patient was diagnosed with decompensated
heart failure stage C functional class 3, severe mitral stenosis, mild tricuspid regurgitation, and atrial
fibrillation rapid ventricular response. Thrombocytopenia in this patient was mistakenly diagnosed
with dengue fever and temporarily restraint the patient from taking warfarin. Thus, thrombocytopenia
was linked to rheumatic heart disease and warfarin was administered. The patient was treated with
erythromycin 4x500mg, digoxin 1x0.25 mg, and furosemide 1x40 mg. After treatment, rate control
was achieved and the symptom improved.

Case report 2 : A 34 year-old woman with chief complain of dyspnea and chest pain. On physical
examination, Blood pressure found 100/70 mmHg, heart rate 160 beat/minute with irregularly
irregular pattern, respiration of 30 times/minute, temperature of 36.7 OC, crackles in left and right lung
on auscultation, and pretibial edema.We found free T4: 3.0 ng/dl, TSHs: 0.1 uU/ml. ECG showed
atrial fibrillation with rapid ventricular response.. The result of echocardiography is normal. Holter
monitoring were not executed due to financial issues. The patient was treated with digoxin IV 1x1
ampule, furosemide IV 2x40 mg, warfarin 1x2mg, propylthiouracil 3x100mg. On the second day of
hospitalization, the patient felt better and digoxin IV was switched to propranolol 2x10mg. After 1
more day of observation, the patients condition stabilized, discharged home.

Conclusion: Young patients with Atrial Fibrilation are related to many causes. Thrombocytopenia in
Atrial Fibrilation with Rheumatic Heart Disease may mistakenly diagnosed with dengue fever and
temporarily restraint the patient from taking warfarin.

Keyword: atrial fibrilation, young age, valvular heart disease, thrombocitopenia, thyroid heart disease