A Curious Case of Atrial Fibrillation
Harsh Goel, MD¹
¹Department of Internal Medicine, The University of Texas Health Science Center, Houston, TX, USA
Disclosure: The author has no conflict of interests to declare.
A 23-year-old male with no reported past medical history presents to the Emergency Department due to complaints of shortness of breath and palpitations occurring three hours prior to presentation. The patient states that this has happened twice before with each episode spontaneously abating. Physical examination was remarkable for an irregularly irregular pulse with ECG confirming atrial fibrillation with rapid ventricular response. The patient was started on metoprolol for rate control with improvement in his symptoms.
On further history, the patient endorses a former history of binge alcohol drinking (up to ten drinks in a weekend) and drinking one beer prior to the onset of his symptoms. He denies any symptoms of tremors, heat intolerance, or diarrhea. He does endorse a history of snoring, associated with daytime fatigue and morning headaches. He denies any fevers, chills, productive cough, abdominal pain, or dysuria. He further denies a family history of sudden cardiac death or arrythmias. He denied a personal history of syncope.
Basic laboratory tests, including TSH were unremarkable. Echocardiogram showed preserved biventricular function with no structural abnormalities.
Six hours into the patient’s hospitalization, the patient spontaneously converted to normal sinus rhythm. ECG obtained after conversion was obtained and is shown below (Figure 1).
Figure 1: ECG after spontaneous conversion to sinus rhythm