A 76-year-old woman presents to the office for evaluation of symptoms of weight loss, anxiety, and palpitations. The symptoms started 1 month ago, and are involuntary. She has no prior history of anxiety or palpitations and her only medical history is hypertension for which she is taking losartan.On examination, the blood pressure is 120/70 mm Hg, heart rate is 100/min and regular. On auscultation the heart sounds are normal and the lung clear. There is a thyroid goiter, warm skin, and a fine tremor in her hands. Which of the following is the most likely cardiac finding?
Correct Answer: paroxysmal atrial fibrillation
Description: Atrial fibrillation is particularly common in older individuals with hyperthyroidism. Thyroid disease may affect the heart muscle directly or there may be excessive sympathetic stimulation. Common symptoms of thyrotoxic heart disease include palpitations, exertional dyspnea, and worsening angina. Pericardial effusion, and aortic insufficiency are not usual finding in thyrotoxicosis, and the cardiac output is increased in hyperthyroidism, not decreased.
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