ABSTRACT
History and examination A 72-year-old man with a history of paroxysmal atrial fibrillation was started on flecainide 4 weeks ago. He has presented to A&E with palpitations and shortness of breath on exertion. He is currently on warfarin, flecainide and ramipril. He has a previous medical history of hypertension. On examination, he looks sweaty with an initial pulse of 150 bpm regular, blood pressure (BP) 140/90mmHg, jugular venous pressure (JVP) is rapidly pulsating and difficult to interpret, his chest is clear and there is no ankle oedema.
