Denies any recent stimulants, caffeine, illicit medications.
States is admherent to rate control medications.
Suspect atrial fibrillation with RVR.
Upon arrival in the emergency department, patient was evaluated for stability.
Upon arrival in the emergency department, an EKG was obtained emergently. EKG, as described above revealed atrial tachycardia with rapid ventricular response.
Given patient is stable with atrial fibrillation with tachycardia will elect for pharmacologic rate control.
diltiazem 20 mg IV under my direct observation.
Subsequent to that patient had continued atrial tachycardia dose refractory to initial management.
Diltiazem drip at 5 mg per hour initiated emergently with titration goals of heart rates to 110s with hold parameters for hypotension.
Unlikely medication noncompliance given patient states he is compliant with his medications for rate control.
Unlikely electrolyte derangements given electrolytes evaluated which were nonremarkable.
Unlikely infectious precipitant given on review of systems and examination, there is no obvious infectious cause.
Unlikely ischemic event precipitant given history not typical for myocardial ischemia and negative troponin.