New onset Atrial fibrillation

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Submitted by Dr T on March 30, 2012 – 9:32am

Last week I went to my primary doctor because I had not been able to sleep for more than 4 hours a night for months.  He diagnosed me with atrial fibrillation after performing an EKG and referred me to a cardiologist. I am a 40 year old male / nonsmoker. The EKG says ventricular rate 75 bpm atrial rate 234 bpm duration 92ms QT 399ms R axis 45 degrees T axis 42 degrees Atrial fibrillation with controlled ventricular response Poor R wave progression. The cardiologist can’t see me for 2 weeks. My heart feels like it is going to beat out of my chest (which is basically how I have felt for months).  He prescribed enteric coated aspirin 325 mg. and performed blood work which all came back normal. Does the ekg indicate that I should go to the hospital Er immediately or should I be okay to wait (of course, barring anything that I would “think” is a heart attack or stroke). Also, does the Poor R wave progression mean that I have probably had a previously “unknown” heart attack? And is there anything else that jumps out at you on the EKG? CC me a copy of my answer.

Hi Joe,
The cardiologist would have seen you immediately if he was concerned. I assume he told your doctor it was OK to wait these two weeks. Nonetheless, I am a little surprised for the delay, because any new onset AF is associated with an increased risk of stroke, while treatment and/or conversion to a normal rhythm becomes more difficult as time goes by. Many doctors would prescribe some form of anti-coagulation such as coumadin or the new drug Dabigatran (with associated additional risks).
Hope this helps,
Dr T

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