Atrial Fibrillation Case 3
A 72-year-old man presents to the ED with weakness, shortness of breath and a cold right hand. He has had a productive cough for two weeks, the cold arm for two days, and the shortness of breath began about six hours previously.
His past medical history includes angina pectoris, hypercholesterolaemia and hypertension.
His current medications are:
- Atorvastatin
- Clopidogrel
- Atenolol
- Ramipril
On examination:
- He is clammy
- There is no cyanosis
- His pulse is 110 bpm and the rhythm is irregularly irregular
- Blood pressure is 150/98 mmHg
- There is a mild mitral regurgitation murmur and pitting ankle oedema
- His respiratory rate is 28 per minute and there are inspiratory crackles to the mid zones
- Examination of the right arm reveals distal cyanosis, coolness, pallor, and the absence of a radial pulse.