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.

Physical Findings:

*Age: 32 years
*Gender: Female
Race: Caucasian
Height: 1.83 m
Weight: 83.92 kg
*Blood Pressure: 135/82 mm Hg
*Pulse: 58 bpm
Respiration: 10 breaths/min
General Appearance: Comfortable
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?

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