Atrial Fibrillation (new)

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with ‍a new onset of atrial fibrillation

Current symptoms: ‍none

‍palpitations

‍shortness of breath

‍fatigue

‍dizziness

‍syncope

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



Worsening factors: ‍none

Alleviating factors or treatments tried: ‍none, ‍effectiveineffective



Contributing factors:

‍obesity

‍smoking

‍alcohol

no history of: ‍arrhythmias, ‍hypertension, ‍coronary artery disease, ‍stroke, ‍thyroid disease, ‍diabetes, ‍liver insufficiency, ‍chronic kidney disease

no use of: ‍anticoagulants, ‍antiplatelets





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 ‍new onsetlikelypossible

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, ‍d-dimer

- Chest X-ray

- Echocardiogram

- Holter monitor

- Stress test

Treatments:

- ‍Rate control

- ‍Rhythm control

- ‍Anticoagulation

- Electrical cardioversion

Further care:

- Referral to cardiologist

- Follow-up in ‍ ‍daysweeks

- 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