Thursday, September 8, 2011

A little; no, an occasional; no, all day long

An 81 y/o male was seen last week.

His cardiac exam was abnormal and an EKG confirmed he was in atrial fibrillation with a heart rate in the 130-140 range.

He was asymptomatic.

Recent labs were normal.

Me: Do you drink alcohol at all?

Patient: A little; only an occasional glass of wine. I don't drink any hard stuff or beer.

Me: Really, that's all?

Patient: That's all.

I decided to control his heart rate with medication and start warfarin as an outpatient.

An echocardiogram was ordered.

He returned 48 hours later and was doing well with a heart rate in the 80's.

He would be referred for an elective cardioversion (to try to convert his heart into a regular rhythm) once his INR (blood thinning level) was within a therapeutic range for a few weeks.

He returned last evening (3 days after his last visit), as I was about to "walk out the door."

His wife was with him.

He was tremulous, shaking and his heart rate was 180-220.

His wife let me know he stopped drinking after our last visit 3 days ago.

Me: He mentioned he had an occasional glass of wine.

Wife: Oh no, he buys a 3 liter bottle of Carlo Rossi blush wine at least every other day. He drinks all day long. He got worried about his health and decided to completely stop.

Me: Thanks, that helps to explain a lot.

He was now in the midst of some alcohol withdrawl symptoms, in addition to his new onset atrial fibrillation.

He was admitted to the hospital.

It amazes me that I remain as trusting (gullible) of patients as I do after all these years. I suppose the alternative is just too depressing.

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