A 58-Year-Old Man With New Onset Atrial Fibrillation

Introduction. A previously healthy 58-year-old man presents to the clinician’s office with a sensation of intermittent palpitations of about 1 week’s duration.

Patient history. Initially, the patient sensed brief palpitations several times during the day, which would resolve in minutes. In the last 2 days, the episodes lasted much longer, and he would feel them in bed at night. Additionally, when going up a flight of stairs, he experiences shortness of breath and the sensation of his heart racing. He had never had these symptoms previously. His health had been excellent, with his only medical diagnosis being mild hyperlipidemia, which was well controlled with statins. He believes he is in good physical shape. He does not smoke, and he consumes less than seven drinks/week.

Physical examination. The patient’s physical examination reveals a well-developed man without distress. His blood pressure measures 130/72. His pulse is irregular, 96 per minute, and his respirations are 14 per minute. His chest is clear without congestion. His heart examination reveals irregular rhythm (96-100 beats per minute with variable intensity), S1 sounds but without murmurs or gallops. There is no pedal edema.

The patient’s STAT blood test shows a complete blood count within normal range. His metabolics and biochemistry screens are also within normal ranges. Additionally, the patient’s troponins are within normal limits. An office electrocardiogram (EKG) reveals atrial fibrillation at 100 per minute. There are no acute injury currents, and there is no evidence of left ventricular hypertrophy.