A 65-year-old woman with a history of rheumatic fever in her childhood now presents with increasing fatigue, palpitations, and episodes of lightheadedness. On examination, she has an irregularly irregular heart rhythm. What might be the cause and what are the next steps?
This patient's symptoms and physical exam findings, along with her history of rheumatic fever, suggest she may have developed mitral stenosis leading to atrial fibrillation and subsequently heart failure. The next steps would be to confirm the diagnosis with an echocardiogram to visualize the mitral valve, perform an ECG to confirm atrial fibrillation, and initiate treatment for heart failure and rate control for atrial fibrillation.