New-onset atrial fibrillation

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Case history #1

A 65-year-old man with a history of hypertension, diabetes mellitus, and hyperlipidemia presents to the emergency department with the first episode of rapid palpitations, shortness of breath, and discomfort in his chest. These symptoms started acutely and have been present for 4 hours. Physical exam shows an irregularly irregular radial pulse at a rate between 90 and 110 bpm, BP 110/70 mmHg, and respiratory rate of 20 breaths per minute. Heart sounds are irregular, but no third or fourth heart sound gallop or murmurs are audible. There are no other abnormalities on examination.

Case history #2

A 56-year-old woman with a 6-week history of weight loss, anxiety, and insomnia presents with palpitations and dyspnea. Her pulse rate is irregular at 140-150 bpm. Her BP is 95/55 mmHg. She looks thin, frail, and rather anxious and jittery. Her palms are sweaty and have fine tremors. She has a palpable smooth goiter. Examination of the eyes shows bilateral exophthalmoses.

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