ABSTRACT

This woman has atrial fibrillation with a fast ventricular response. The ECG shows atrial fibrillation: note that there are no P waves before the QRS complex, which is narrow, and that the heart rate is irregularly irregular. The fast rate and the loss of atrial transport from the fibrillation will impair cardiac function. The basal inspiratory crackles suggest that she has LV dysfunction. The chest X-ray shows fluffy, interstitial shadowing and prominent upper-lobe blood diversion, suggestive of pulmonary oedema.