Case history
Case history
A 70-year-old woman with a history of hypertension, diabetes mellitus, hyperlipidemia, and prior myocardial infarction presents to the emergency department with palpitations and shortness of breath. These symptoms started 2 days ago. She was diagnosed with atrial fibrillation with rapid ventricular rate response a year and a half ago, at which time an attempted direct current cardioversion and a trial of sotalol to maintain sinus rhythm and prevent further episodes of AF were unsuccessful. The patient was treated with digoxin and metoprolol to control rate and warfarin to prevent stroke. Current physical exam shows that she is febrile and has an irregularly irregular radial pulse at a rate between 90 and 110 beats per minute, blood pressure 100/70 mmHg, and respiratory rate of 26 breaths per minute. Heart sounds are irregular, but no third or fourth heart sound gallop or murmurs are audible. The breath sounds are of bronchial character associated with crepitations over the left basal lung area.
Other presentations
In an older patient the symptoms may be as subtle as a decrease in mentation or listlessness. In others the first symptom may be syncope, cardiac arrest, stroke, or congestive heart failure.[4][5]
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