Mrs. L is an 81-year-old female who reports for her annual cardiology visit. She feels well from a cardiac standpoint. Her primary complaint is the current number of medications she is prescribed and wishes to discuss the possibility of discontinuing some of these.

CV comorbidities: Atrial fibrillation (PVI ablation 2/2014 and cardioversion in 9/2015), and no prior history of coronary events.

Non-CV comorbidities: Arthritis, hypertension, chronic kidney disease (stage 3), hyperlipidemia, anxiety, bilateral sensorineural hearing loss, gastroesophageal reflux disease (GERD).

Review of Systems: No chest pain, no complaints of palpitation, no syncope.

Physical Exam: She is overweight with a body-mass-index of 33 kg/m2. Her pulse is 81 bpm, blood pressure is 126/68 mm Hg, and heart rate is irregularly irregular without murmurs, lungs are clear to auscultation.

Tests: Electrocardiogram: Atrial fibrillation, rate 75-80 bpm. Echocardiogram: ejection fraction — 50-55%, no significant valvular disease.

Medications: Acetaminophen 500 mg 1-2 tablets every 4 hours if needed for arthritis pain, aspirin 81 mg daily, atorvastatin 40 mg daily, escitalopram 10mg daily, losartan 25 mg daily, metoprolol succinate 50 mg daily, pantoprazole 40 mg daily, warfarin 1 mg daily

Total Number of Medications: 8

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Dyslipidemia, Geriatric Cardiology, Prevention, Valvular Heart Disease, Anticoagulation Management and Atrial Fibrillation, EP Basic Science, Atrial Fibrillation/Supraventricular Arrhythmias, Hypertension

Keywords: Geriatrics, Aspirin, Atrial Fibrillation, Heart Rate, Warfarin, Electric Countershock, Metoprolol, Acetaminophen, Citalopram, Losartan, Blood Pressure, Body Mass Index, Hyperlipidemias, Stroke Volume, Electrocardiography, Hearing Loss, Sensorineural, Renal Insufficiency, Chronic, Gastroesophageal Reflux, Heart Valve Diseases, Hypertension, Arthritis

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