72 year old man

Introduction

• A 72 year old man reports fatigue & an unintentional weight loss of 3.6 kg during the past 8 weeks.
• He has a history of atrial fibrillation & coronary artery disease
• Current medications are aspirin, lisinopril, amiodarone, rivaroxaban & sublingual nitroglycerin PRN.

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• Heart rate is irregularly irregular at 122/min.
• He is restless & diaphoretic.
• Thyroid is palpable but not enlarged & without nodules or tenderness.
• There is no chemosis or exophthalmos.
• Lungs are clear to auscultation.

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• Neurologic examination is notable for brisk symmetrical deep tendon reflexes.
• Electrocardiography shows atrial fibrillation.
• Laboratories only notable for serum TSH of 0.015 uU/mL.

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• In addition to starting a beta-blocker, what is the best initial treatment?

More general terms

• case presentation