A 65-year-old man with a history of CHD presents with shortness of breath and fatigue. He has noticed that these symptoms have been worsening over the past month. On examination, his pulse is irregular. An ECG shows atrial fibrillation. What are the potential causes and the next steps?
This patient's symptoms could be due to heart failure, which can be a complication of CHD. The atrial fibrillation could be a contributing factor as it can impair the heart's efficiency. Further tests like an echocardiogram to assess heart function, and blood tests for BNP/NT-proBNP (markers of heart failure) would be useful. Anticoagulation should be considered to reduce the risk of stroke in atrial fibrillation, and rate or rhythm control would likely be necessary.