Irregular irregularities

Scenario

AN 83-YEAR-OLD female patient is new to your practice and presents for a checkup and repeat prescriptions. She has a history of chronic airways disease managed with long and short acting beta-agonists. She is known to have an idiopathic cardiomyopathy that has responded partially to treatment. Her last known ejection fraction was 40%. A cardiac catheter performed four years ago showed minor coronary disease. She has had documented atrial fibrillation associated with pneumonia in the past.

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