aFIB + RVR + CHF


CHF, COPD, aFIB, and DM2 p/w 3d cough, worsening SOB, and one day of nausea/vomiting c/f acute decompensated HF. BUS shows moderately reduced EF though hard to assess given tachycardia. aFib w RVR present on admission. Active smoker.


Unlikely PE: sustained tachycardia more likely from afib, SOB but not on any exogenous estrogen, no recent travel or operations, no CA history, ambulatory at home.
Possible COPD exacerbation: new cough, h/o COPD, wheezing on initial exam
Unlikely tamponade. Unlikely MI- trop indeterminate, will trend trop and ekg inpatient, possibly demand ischemic elevation.
Not PTX: normal CXR, bilateral lung sounds
Not Esophageal rupture: no dysphagia
Not PNA:  SOB, cough, but afebrile and CXR negative


Pt in mild to moderate acute decompensated HF currently in mild respiratory distress and has not responded to rate control with 10mg Dilt; Bblockers contraindicated. Treating for CHF with Lasix IV and considering amiodarone as well as digoxin as a secondary agent.     Amiodarone 150 IV load, then 1mg /min 6 hr, then .5mg/18hr.  30 PO q6 dilt.

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