Sun14November1246PM 1

A 55-year-old male has a history of paroxysmal atrial fibrillation.

Despite treatment with digoxin and bisoprolol, he continues to experience episodes of uncontrolled tachycardia precipitating acute left ventricular dysfunction. He has therefore been commenced on amiodarone.

Which investigation is mandatory before starting amiodarone?

(Please select 1 option)

Troponin T

Fasting blood glucose Incorrect answer selected

Thyroid function test This is the correct answer

Fasting lipid profile

eGFR

Explanation

Amiodarone can cause disorders of thyroid function, both hypothyroidism and hyperthyroidism.

Clinical assessment alone can be unreliable, therefore the BNF recommends laboratory testing pre-treatment and every six months while therapy is ongoing.

Thyroxine (T4) can be elevated in the absence of hyperthyroidism due to inhibition of the conversion of T4 to triiodothyronine (T3); therefore thyroid-stimulating hormone (TSH) and T3 should always be tested.

Amiodarone can be hepatotoxic therefore treatment should be discontinued if evidence of liver dysfunction develops.

Answer Statistics

1

1%

2

1%

3

95%

4

1%

5

4%

Times answered: 252