Atrial Fibrillation (A fib) with Rapid Ventricular Response

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A fib with RVR

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Atrial fibrillation with RVR, new onset, likely 2/2 to __________ (or unknown etiology)
-DDx includes Atrial tachycardia, vs Multifocal atrial tachycardia vs Wolf-Parkinson-White syndrome vs Atrioventricular nodal reentry tachycardia.
-EKG confirms atrial fibrillation due to absent p waves and irregular irregular rate.
-Risk factors include OSA, alcohol, age, HTN
-Will admit the pt to telemetry bed.
–CHA2DS2-VASc score= XXXX, HAS-BLED score= XXXX.
-Will rate control with either Beta blocker vs calcium channel blocker.
-Will also consider rhythm control with Amiodarone +/- Digoxin pending conversation with cardiology.
-Goal rate of < 85 bpm for symptomatic patients and <110 bpm for asymptomatic patients. 
-Initiate heparin drip for anticoagulation for possible TEE cardioversion.
-Switch to oral anticoagulants post procedure, preferably NOAC as the patient has no evidence of moderate to severe mitral stenosis with a mechanical heart valve which would have warranted warfarin.
-May benefit from percutaneous left atrial appendage occlusion if the patient has contraindication to long term anticoagulation. Will discuss with cardiology.
-Cardiology consulted. Dr. X will see pt.
-Electrical or chemical cardioversion per cards recs.
-F/u TSH and free T4, serial Troponins,  Pro-BNP.
-TTE (transthoracic echo) ordered.
-Sleep study when discharged for OSA.