tokens: 974381789 PUOMC 0520610 70648 390115 12/25/1996 12:00:00 AM ATRIAL FIBRILLATION . Unsigned DIS Report Status : Unsigned DISCHARGE SUMMARY NAME : LENKPRUSKIHKOOGLEKIH , NIEKERO C UNIT NUMBER : 449-50-82 ADMISSION DATE : 12/25/96 DISCHARGE DATE : 12/29/96 PRINCIPAL DIAGNOSIS : Atrial fibrillation . ASSOCIATED DIAGNOSIS : History of multinodular goiter ; history of hypertension ; history of subtotal thyroidectomy . PRINCIPAL PROCEDURE : Electrical cardioversion . HISTORY OF PRESENT ILLNESS : Ms. Lenkpruskihkooglekih is a 63-year-old lady with a history of frequent premature ventricular contractions and infrequent short runs of non-sustained ventricular tachycardia ( one four-beat run ) in 1991 , for which several antiarrhythmic agents including Propranolol , Quinidine , Procainamide , Tenormin , Norpace , Corgard , and Flecainide were used , but were stopped because of intolerance . At that time , she had clear coronary arteries on coronary angiography and an ejection fraction greater than 50% . She did well off antiarrhythmic agents until October of this year when she was noted to have atrial fibrillation with a rapid ventricular rate after several days of decreased exercise tolerance . She was started on Coumadin and had a failed attempt at DC electrical cardioversion on 11/16/96 . She has been on Coumadin since and has continued to have occasional palpitations and mild shortness of breath . PAST MEDICAL HISTORY : Includes a history of hypertension ; multinodular goiter ; subtotal thyroidectomy . MEDICATIONS : Include Cardizem CD 180 mg daily ; Monopril 10 mg daily ; Digoxin .25 mg daily ; and Lasix 40 mg every other day . ALLERGIES : To Quinidine , Procardia , and sulfa antibiotics . PHYSICAL EXAMINATION : On examination , blood pressure was 200/100 ; heart rate 120 per minute ( atrial fibrillation ) . The patient was noted to be anxious . There was no neck vein distension or carotid bruits . Heart sounds were normal . The lungs were clear . The abdominal examination was benign . There was no peripheral edema . Pulses were all easily palpable . LABORATORY DATA : A 12-lead electrocardiogram showed atrial fibrillation with a QT interval of .46 seconds . There were diffuse ST segment and T-wave abnormalities , which were nonspecific . A complete blood count , electrolytes , BUN and creatinine were within normal limits . INR was elevated at 2.5 . An echocardiogram was performed , which showed completely normal left ventricular systolic function with an ejection fraction calculated at .74 . There was no evidence of left ventricular hypertrophy or asymmetric septal hypertrophy , which had been an issue that had been raised on an echocardiogram in Ownra Cin , New Mexico on 12/06/96 . HOSPITAL COURSE AND TREATMENT : The patient was started on Propafenone 300 mg three times a day and underwent an attempt at electrical cardioversion after seven doses of this . This failed , despite one shock at 300 joules and two shocks at 360 joules . The Propafenone was stopped , and the patient was changed to Amiodarone 400 mg t.i.d. , which was continued for two days . The patient was discharged to home on Amiodarone 200 mg daily on 12/29/96 . An electrocardiogram showed no evidence of QT prolongation prior to discharge , and pulmonary function tests will be performed before the patient goes home today . The patient will follow up with Dr. Ther Ludzjesc at Shiekeu Hospital Medical Centers in Connecticut . In addition , she will return to this hospital in early February for repeat attempt at electrical cardioversion on Amiodarone . She will continue her Coumadin until then and arrangements for her readmission can be made through Dr. Iceca Rhaltkaaispehbreun 's office here . MEDICATIONS : Other than the addition of Amiodarone 200 mg daily , will be the same as her admission medications . STA BODEJOVE , M.D. DICTATING FOR : ICECA RHALTKAAISPEHBREUN , M.D. cc : Dr. Ther Ludzjesc Director , Section of Cardiology Shiekeu Hospital Medical Centers NC TR : sip DD : 12/29/96 TD : 12/29/96 10:03 A cc : ICECA RHALTKAAISPEHBREUN , M.D.