Problem: An 86 year old female presents to the ER with complaints of heart palpitations since yesterday morning. Pt states she feels like her heart is going to pop out of her chest. Pt states she has a history of irregular heart rate and was in the hospital two months for the same thing. On assessment, pt's radial pulse is irregular and hard to count. Pt is placed on an EKG monitor and is found to be in Atrial Fibrillation with rapid ventricular response. Pt heart is 130-160s, BP 108/60, 02 Saturation is 98% on RA. Pt states that she takes Cardizem 30mg PO Daily, Coreg 3.25mg PO BID, and Coumadin 2.5 mg PO Daily. However, pt states she hasn't been able to afford her prescription of Cardizem this month and ran out of the medication three days ago. Lab and Diagnostic work shows: INR-2.3, Troponin level < 0.02, WBC 8.3, Hgb 14, Hct 36. 1.
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