A 68-year-old male presents with palpitations, lightheadedness, and weakness.

These symptoms appear to worsen with increased alcohol intake. Medical history is significant for hypertension being treated with hydrochlorothiazide. On physical exam, the patient appears uncomfortable. There is an irregularly irregular pulse when palpating the radial artery. On cardiac auscultation, the first heart sound (S1) is of variable intensity. There is mild bibasilar crackles on pulmonary auscultation and an absence of peripheral edema. An electrocardiogram is obtained. What is your diagnosis? What is the treatment plan?"

The clinical scenario combined with the investigations being suggestive, the diagnosis in this case is most probably atrial fibrillation (AF).

 Diagnosis

 Atrial Fibrillation (AF)

 Reasoning:

 Irregularly Irregular Pulse: The irregularly irregular rhythm is characteristic of atrial fibrillation, hence, some authors refer to it as a rhythm with ‘abracadabra’ nature.

 Variable Intensity of S1: This could be suggestive of a variable ventricular filling especially due to the ine move of the atria.

 Palpitations, Lightheadedness, Weakness: Some of the familiar signs of AF include.

 Worsening Symptoms with Alcohol Intake: Also, one must be cautious about alcohol consumption because it can both initiate and worsen the condition of atrial fibrillation.

 Bibasilar Crackles: May indicate chronic atrial fibrillation which is a frequent cause of heart failure in patients with structural heart disease.

 Treatment Plan

 Immediate Management

 Rate Control:

 Medications:

 Anticoa Hullators (e. g. , Metoprolol) or Calcium Antagonists (e. g. , Diltiazem) to reduce the ventricular rate.

 Objective: Maintain a controlled heart rate while at the same time stopping symptoms associated with it and potential hazards.

 Anticoagulation:

 Assessment: Want to know your chances of a stroke? Calculate with CHA2DS2-VASc score.

 Medications: If indicated, start anticoagulatory treatment for stroke prevention, with agents including Warfarin or DOACs (such as Dabigatran or Rivaroxaban).

 Symptom Relief:

 Diuretics: Ask if there is any sign of heart failure (there is no peripheral edema at this stage though).

 Long-Term Management

 Rhythm Control:

 Antiarrhythmic Medications: (e. g. , Dofetilide, Sotalol) for maintaining sinus rhythm – these drugs intercalate with sodium channels in the cardiac action potential plateaus.

 Electrical Cardioversion: May be regarded if the patient still experiences symptoms and satisfactory rhythm control cannot be attained using drugs.

 Lifestyle Modifications:

 Alcohol Reduction: The presence of AF may be precipitated by alcohol consumption therefore recommend moderation in alcohol use.

 Blood Pressure Management: Go on closely monitoring hypertension, perhaps with reconsideration of the existing antihypertensive treatment.

 Follow-Up and Monitoring

 Regular Monitoring:

 ECG: ,Screening after two weeks, four weeks, eight weeks and then every month to take check on the rhythm and the efficiency of the treatment.

 Anticoagulation Monitoring: In this case: Blood test regularly if on Warfarin to confirm its appropriateness for the patient’s INR.

 Education

 Patient Education:

 Explain to the patient the meaning of the detected condition atrial fibrillation, symptoms and signs to identify, and the factors that dictate the necessity of compliance with medical recommendations.

 References

 January, C. T. , Wann, L. S. , Calkins, H, et al (2019). 2019 American Heart Association/American College of Cardiology/Heart Rhythm Society Focused Update for the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society Guideline for the Management of Patients With Atrial Fibrillation. Circulation, 140(2), e125-e151. doi:10. 1161/CIR. 0000000000000665.

 Patients and the public should be informed, and they should have access to the present paper’s supplementary material with its updated and extensive list of derivatives of rebaudioside A. Hand held ECG device for detecting AF, its efficacy in a cardiology and geriatric ward population. Europace, 20(1), 50-56. doi:10. 1093/europace/eux164.

 Depending on the Interpretation of this electrocardiogram and other investigations that may be done, the plan should be developed on the following plan.