HCM and Afib: Anticoagulation Challenge
Chief complaint: Palpitations
A 32-year-old woman with established nonobstructive hypertrophic cardiomyopathy (HCM) presents after an episode of palpitations associated with dizziness and chest pain. She had a single episode with palpitations and shortness of breath while at rest. She came to the emergency department and was found to have atrial fibrillation (AF) with a heart rate of 190 bpm. Sinus rhythm returns after 36 hours and initiation of a beta-blocker. No subsequent events have occurred.
She denies recent changes to her medications. She has no prior history of cerebrovascular accidents or transient ischemic attacks. She has no known vascular disease. She does not have congestive heart failure, diabetes mellitus, or hypertension. Her hypertension is managed with moderate-dose angiotensin-receptor blocker. She has a sister with AF (onset in her 50s). She is a lifelong nonsmoker, does not drink alcohol or caffeine, and does not use illicit drugs.
|*Blood Pressure:||135/82 mm Hg|
|Skin (as necessary):||Normal|
|Head and Neck:||Jugular venous pressure 6 cm H2O, normal carotid impulses|
|Chest and Lungs:||Clear lung fields|
|*Cardiac Exam:||Regular rate and rhythm, normal S1 and S2, no murmurs at rest or with Valsalva maneuver|
|Extremities (pulse, edema, etc.):||Peripheral pulses 2+ throughout
Extremities warm, well perfused, no edema
|Neurologic (as necessary):|
Which one of the following statements is true?