Practice Case 67

A 68-year-old woman with a known history

of paroxysmal atrial fibrillation on digoxin
therapy and uncontrolled hypertension presents

rhythm. One week later the woman calls her PCP

with complaints of fatigue, breathlessness with
minimal exertion, and muscle aches. She has also

What are the findings

on the ECG?
to her primary care physician (PCP) for follow-up noted an irregular pulse. She denies angina. She is Do they explain
of her hypertension. Her blood pressure continues brought into the urgent care clinic, where her her symptoms?
to be mildly elevated despite calcium-channel physical exam is notable for a pulse of 54 bpm,
blocker therapy, and she is started on hydro- and her blood pressure and cardiopulmonary What is the etiology
chlorothiazide. Per her usual state, she is in sinus exam are normal. An ECG is obtained. of these findings?
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