Atrial Fibrillation follow-up

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Returns for ‍atrial fibrillation follow-up

Last visit was ‍ ‍months ago

Progress since last visit: ‍unchangedimprovedworsenedvariable in intensityresolved



Current symptoms:

‍palpitations

‍shortness of breath

‍fatigue

‍dizziness

‍syncope

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild



Heart rate: ‍ bpm, ‍regularirregular

Blood pressure: ‍/‍ mmHg



Worsening factors: ‍none

Alleviating factors or treatments tried: ‍none, ‍effectiveineffective



Contributing factors:

‍obesity

‍smoking

‍alcohol

history of ‍arrhythmias, ‍hypertension, ‍coronary artery disease, ‍stroke, ‍thyroid disease, ‍diabetes, ‍liver insufficiency, ‍chronic kidney disease

use of ‍anticoagulants, ‍antiplatelets



Smoking: ‍neversmokerformer smoker, ‍ pack-years

Alcohol: ‍nonesociallyexcessive, ‍ drinks per ‍dayweek

Caffeine: ‍ daily



Diet: ‍goodaveragepoor, ‍high in salt, ‍high in carbs, ‍high in fat, ‍vegan

Physical activity: ‍adequateaveragesedentary

Weight: ‍ ‍lbskg, ‍gainunchangedloss



Impact on daily activities: ‍minimalmoderateseveredebilitating

Overall quality of life: ‍goodaveragepoor ‍



ECG: ‍ ‍normalatrial fibrillationatrial flutter

Echocardiogram: ‍ ‍unremarkableleft atrial enlargementreduced ejection fraction

Stress test: ‍ ‍normal

Holter monitor: ‍ ‍atrial fibrillation episodesno significant arrhythmias



Medications:

‍anticoagulants, ‍antiarrhythmics, ‍beta blockers, ‍calcium channel blockers, ‍digoxin

Adherence: ‍goodaveragepoor, ‍adverse effects





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Atrial fibrillation ‍stable

DDx: atrial fibrillation, atrial flutter, supraventricular tachycardia, sinus tachycardia, ventricular tachycardia, premature atrial contractions, premature ventricular contractions, thyroid disorders, pulmonary embolism, pneumonia, chronic obstructive pulmonary disease, acute coronary syndrome, myocarditis, pericarditis, cardiomyopathy, electrolyte imbalances, alcohol intoxication, stimulants abuse





PLAN:

Investigations:

- ECG

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍TSH, ‍troponin, ‍INR/PTT if on anticoagulation

- Holter monitor

- Echocardiogram

- Stress test

- Sleep study

Treatments:

- ‍Rate control

- ‍Rhythm control

- ‍Anticoagulation

- Electrical cardioversion scheduled for ‍

- Catheter ablation

- Left atrial appendage closure

Further care:

- Referral to cardiologist

- Referral to electrophysiologist

- Follow-up in ‍ ‍daysweeks

- Lifestyle modifications: weight loss, exercise, alcohol moderation, smoking cessation

- Return if symptoms worsen or if new symptoms develop such as chest pain, shortness of breath, or fainting

- Referral to ER if severe chest pain, severe shortness of breath, or fainting occurs

- Consideration of sleep apnea treatment if applicable

- Anticoagulation clinic referral for INR monitoring if on Warfarin