A 33-year-old homeless man is brought into the Emergency Department by police after they found him barely arousable on the street next to an empty bottle of vodka. The patient has psychomotor slowing on examination, and a further history cannot be obtained. The ECG technician tells you that the patient has an abnormal heart rhythm.
Which of the following is the most likely diagnosis?
A. Sinus tachycardiaAtrial fibrillation. Atrial fibrillation is a common arrhythmia, and this patient is at risk from apparent alcoholism. Common causes of atrial fibrillation include hypertension and any underlying heart disease, such as congestive heart failure (CHF), hypertrophic cardiomyopathy, previous myocardial infarction, and anything causing left atrial dilation. A useful mnemonic for remembering some of the causes of atrial fibrillation is PIRATES: Pulmonary disease, Ischemia, Rheumatic heart disease, Atherosclerosis/Atrial myxoma, Thyrotoxicosis, Ethanol, Sepsis. (A) Sinus tachycardia is an abnormal rate (not rhythm), so this does not answer the question. (B, D, E) Heart block, Wolff–Parkinson–White, and torsades de pointes are not nearly as common as atrial fibrillation in the general population or in alcoholics.