Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for follow-up of persistent atrial fibrillation (AF), defined as AF lasting >7 days or requiring cardioversion. Patient reports [palpitations/fatigue/dyspnea/asymptomatic]. Current rhythm status: [rate-controlled/uncontrolled]. Review of systems negative for syncope, chest pain, or TIA symptoms. Adherence to anticoagulation and rate-control therapy is [confirmed/suboptimal].
Clinical Examination Findings
Cardiovascular exam: Irregularly irregular heart rhythm noted on auscultation. Pulse deficit present. S1 and S2 heart sounds audible without murmurs, rubs, or gallops. No signs of decompensated heart failure (no JVD, no peripheral edema, lungs clear to auscultation). Peripheral pulses are symmetric and palpable.
Treatment Protocol
Plan: 1. Continue anticoagulation therapy [Drug/Dose] for stroke prophylaxis (CHA2DS2-VASc score: [Score]). 2. Rate control strategy: [Beta-blocker/CCB/Digoxin] titrated to target resting HR <80-110 bpm. 3. Rhythm control strategy: [Consider cardioversion/Antiarrhythmic therapy/Referral for PVI ablation]. 4. Monitor for signs of thromboembolism or bleeding.