60 year old male with no known medical history (has not seen physician in many years) presents to the hospital with weakness and shortness of breath.
On arrival to the ED, he is noted to be very tachycardic, with a heart rate in the 150-160s. EKG revealed atrial flutter. He is started on metoprolol with no improvement, then on diltiazem drip which is increased to the maximum rate but his heart rate doesn't budge.
The ER doctor has consulted cardiology and is awaiting a call back. In the meantime, you are called to admit the patient.
VITALS
T 98.4 HR 162 BP 152/78 RR 25 SPO2 98% on RA
EXAM
Gen: in moderate respiratory distress but speaking in full sentences, appears uncomfortable
CVD: very tachycardic, unable to discern murmurs
Lung: crackles bilaterally
Abd: snt
Extremities: trace edema bilaterally
LABS
WBC 65,000 (5% bands, 60% neutrophil)
Hgb 10
Plt 2100
BUN 20
Cr 1.1
Trop 0.0
BNP 208
LDH 1500
EKG
POCUS
Parasternal long
Parasternal short
Subcostal
IVC
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