Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 166: A 64-Year-Old with Fatigue, Difficulty Sleeping, and Dyspnea on Exertion
Oct 2, 2025
This discussion centers around a 64-year-old man experiencing fatigue, insomnia, and palpitations. The hosts delve into the diagnosis of new atrial fibrillation, backed by an ECG confirmation. They highlight the serious risks associated with AF, including increased mortality and stroke risk. Acute management strategies are explored, advocating for rate control with beta blockers, along with the importance of anticoagulation prior to cardioversion. Essential anticoagulation guidelines and long-term considerations are also introduced.
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AFib Is Common And Age-Related
- Atrial fibrillation is the most common sustained arrhythmia and increases markedly with age.
- Over 95% of AFib patients are older than 60 and lifetime risk for men >40 is ~25%.
Key Risk Factors To Check
- Hypertension, diabetes, family history, obesity, thyroid disease, and sleep apnea increase AFib risk.
- The hosts recommend checking thyroid function in this patient with new AFib.
AFib Raises Stroke And Mortality Risks
- AFib increases mortality and is responsible for roughly 25% of strokes.
- AFib patients also face higher dementia and cardiomyopathy risk.
