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.