My assessment is that this patient is a 65-year old male with HTN, HLD, HFpEF, s/p Hepatitis C cure in

9/2017 who presented to the ER on 1/6/2018 with subacute onset shortness of breath, congestion and
cough in the setting of atrial flutter with RVR and HR consistently in 130s despite metoprolol and
diltiazem trial.

Atrial Flutter with 2:1 block

-CHADsVASc score: 3
-Continue anticoagulation with apixaban
-Metoprolol 50 mg q6h
-consider digoxin (vs amiodorane) challenge to see if HR stabilizes

Diabetes Mellitus Type 2

-continue sliding scale insulin + Detemir 35 mg
-continue daily glucose monitoring

COPD (presumed) exacerbation

-maintain scheduled nebulizer treatment + steroid taper
-initiate antibiotic prophylaxis with azithromycin for 5-10 days
-repeat CXR to evaluate for consolidation or edema
-monitor pulse oximetry

Heart Failure
-recheck BNP to r/o or support dx of HF (BNP on admission = 200)
-repeat Echo to assess for LV systolic dysfxn (last 45% in March, 2017)