Detection of paroxysmal atrial fibrillation in patient with embolic stroke by active self-management education: a case report

Abstract

The patient is a 65-year-old man was admitted due to the visual disturbance. Neurologic images including cranial CT and MRI showed a cerebral infarction in the right occipital lobe. This infarction was diagnosed as the embolic infarct, but embolic cause including the paroxysmal atrial fibrillation was not detected in further examinations during the hospital stay. He was diagnosed as embolic stroke of undetermined source, however, he was strongly suspected to have undetected paroxysmal atrial fibrillation. He participated in a disease management program for the ischemic stroke recurrence prevention and received self-management educations lead by the disease management nurse. He was educated to measure and record the pulse and blood pressure for himself every day to detect the arrhythmia, especially paroxysmal atrial fibrillation. On the 86th day after the onset, the patient himself noticed the abnormality of blood pressure and irregular pulse in daily check at home and called the disease management nurse. The disease management nurse suspected paroxysmal atrial fibrillation, and suggested him to have a medical examination immediately. As a result, atrial fibrillation was confirmed with an electrocardiogram, and an anticoagulant therapy was started soon after. For the detection of paroxysmal atrial fibrillation in embolic stroke of undetermined source, the self-management education to the patients was proved to be effective.