Scenario: This is a resting rhythm strip for an 88-year-old man. The patient is completing his annual examination with his primary care provider. Compared with last year’s electrocardiogram (ECG), there has been no change in his cardiac rhythm. Overall, he lives independently, goes to the gym 3 times a week, and takes the following medications: metoprolol, diltiazem, and apixaban (Eliquis). He has no complaints of pain and discomfort and wants permission from the provider to visit his son in Italy.

Permanent atrial fibrillation between heart rates of 30 and 75 beats per minute with fragmented QRS complexes and sagging ST segments.

Atrial fibrillation, also called AF or afib, is a heart rhythm generated by multiple foci concurrently in the atrium creating a wavy or quivering baseline, which is why a distinct P wave is absent. The diagnosis is confirmed by palpating for...

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