Next patient malcolm twigg t w I g g 4 0 244 observations blood pressure a 100 over 77 heart rate a 105 on monitor saturation is 95% on air respiratory 18 investigations creatinine 120 at baseline potassium and sodium normal lfts normal crp 3 urea 7.2 ast normal full blood count mild neutrophilia 10.31 but no and with right cells 15.6 recent h b o 1 c april 2025 60 millimoles per mole then will everyone need an ocd yes okay add to the plan add magnesium calcium phosphate onto blood tests ecgs initially rate a hundred and 51 with atrial fibrillation with rapid ventricular response rate improved to 87 this morning atrial fibrillation with some ventricular ectopics and on occasion runs of 3 to 4 beats of ventricular ectopics open brackets nonsustained ventricular tachycardia close bracket help overnight for the ed tube of 2.5 mg of bisoprolol which improved the rate as well there is his previous sotalol 80 mg in the morning hi good morning rob from rocket doctor celeste speaking how are you doing okay yeah good thank you I'm sorry to see you back in hospital with this fast heart rate mhmm the a and e team has been managing that overnight I'll sensibly give you an extra dose of your medication and keep you close to high on your heart rate do you still feel like your heart's racing I never feel like that never feel like that alright I just get my my sports and and the edt mentioned about feeling in your throat that you dealt with before yeah almost as I've a bit of that yeah I I don't know I I've got a bit of anxiety as well do you quite like a bit of a mhmm and do you are you coughing at all or anything like that not particularly your throat's a little bit sore mhmm seems to be a bit a of a sudden death mhmm and then terms of the atrial fibrillation in the heart rate see you're on sotalol have you seen cardiologist about it before heart doctor or is it almost by other people I'm with mel's you're with with mel mel's yeah fine great alright so you see them back here yep I'm I'm happy to put them on brilliant good I'm done what's the plan with this are you planning to burn anything away in your heart or anything like that not so much no just imaging the circuit alright okay I'll have a good look at that to see whether there's anything else we can from that perspective no that's fine sometimes this is driven by infection or electrolyte salts in the blood that are up or down I've asked them to be added on lots of electrolytes to be added onto the blood just to see whether there's anything abnormal or either you can fix and then your rate's going still quite fast they'll probably increase your social loss slightly to try and bring it down why can't you feel that pain if it's so fast yeah it's funny isn't it some people have that feeling and some people don't often when you've been in atrial fibrillation for a while you've lack ed that feeling that the heart's going particularly well and it is a nonspecific feeling that lots of people have a feeling that something's just right and a weird chest discomfort means that you're in but some people have not have also found me to do that no okay sorry not it's always comes off and I've been doing anything strenuous really and we do it's been the entire mhmm yeah we do something strenuous yesterday driving a lot and what has led to you driving a lot the doctor rushed him and he was going to be around showing them the lovely scenes in the bay in in the room in more stuff it's complicated why people go into this atrial fibrillation sometimes caffeine is a factor sometimes alcohol have you been drinking more recently or no I've got no no that's good yeah yeah so you and do you drink alcohol at all that's great I do mainly with me you mhmm even then I've got a couple other things smoking I'll be right and how about smoking smoking more so never smoked do you know anything kind of coming no that's good alright and who lives at home your wife your wife okay fine and how are your who's your brother-in-law you said who's who's your sister is that right who was visiting who's your my wife's cousin your wife's cousin sorry yeah fine and they've got a nice plan today looks like a good good day of weather for it yeah waiting for me to go around where'd you so you can drive them around can I have a quick look at you do you mind yeah hands and listen to your chest I'll just write the pulses your blood pressure's fine with all of this which is good you've had your dose so too long this morning so hopefully that will bring things down even further any shortness of breath going on in your fist patient rotation is that comfortable not really that's good good have you had a chest x-ray yet no alright ask if you're on the phone if that's okay just to make sure something's not really checked in yet these people I do sometimes get a a sensation in middle of the chest mhmm I mean feel like I'm struggling is it a discomfort sort of it's just a feeling it's a little heavy heavy feeling mhmm and do you get that when you're in that class with them near any other time yeah probably do you get it when you play table tennis for example no no alright so it's not associated with strenuous activity it just seems to be when you when you're in this fungal rhythm absolutely any pain in your tummy at all no waterworks bladder imbalance pain in your head I've got ibs mean I'll be in few minutes I'll be there and when I'm in this sort of enormous wing area it affects the bladder about 6 times 6 5 okay yeah okay and what do you do for your ibs do you have any treatment for you it's laxative got stolen blockers when when I'm leperamide yeah no no yeah but I try not to use yeah of course it's hard to work you know mhmm but then we've been able to find the right balance do you have like some fiber in your diet oh yeah that's fine good yeah that's really good I think I've got a little bit that really okay you can't have too much on it can I see your nails tell me about this little black spot there have you been doing something physical hammer hammer's okay fine good and you haven't got any others that's good well table 30 is table 30 I have no idea what that is it's been filled with this but it's paronychia yeah when you get an infection around the nail can be quite painful yeah and then people in the past come and go okay what did you do for a living I was in local government to start by but I went into journalism and living life great do you still do that now retire retire focusing on the take home it sounds like music writing lovely that's nice can I have a look at your legs no swelling in your legs or in your ankles excellent good that's great so what keeps you in hospital is this fast heart rate and it'll take time and more medication to get the rate down once the rate is controlled then we can get down quickly but it's just an annoying factor of this thing sometimes it goes fast there can be lots of reasons that cause it maybe it's pharyngitis that you've got contributing to things or maybe that you've got a small chest infection you've got x-ray checked and all that sort of thing so maybe the salts in the blood are off I'll add salts of blood to that song so just had a few minutes it was this it this was while we're talking about aches and pains okay I'm really worried about it years I've had pain right across the back mhmm 3 single in the hips and the top of the hips mhmm I fell down some concrete steps did you nearly nearly went backwards off it and lost my balance mhmm and then just managed to spin around and scoot down remembers that then it sort of cleared over a little bit but it had to clear down in a 100 steps and prove it no that's you didn't I didn't hit the ground oh wow but yeah just I twisted around think it cleared up it's got a little back there can I have a feel of your abdomen of course oliver is that okay just hold that is it tender no good sorry how about over here are your hips or your ankles no it's not too much well should we x-ray you back and make you haven't broken anything after your fall I think it's called into the ground oh can't get a gram fine it's just a rendering well it's there there's loads of reasons for that laying back there I I mean I can see when you've had a bone injury sometimes you have small breaks in the back when you've got those breaks in the back which can happen even after low impact when you're in your 80s as you are now I tore my surgical a few years back oh well that's insane do you get any I think it's term came in the symptoms as well like did you up on the most side of things I know that I don't do as well but how of this do you ever get into the same job no good that's good well I've done a cure about that lately I'm not a massive hospital I've been so much been a while right we'll get a few get a few tests back through I'll actually be back to about 6 weeks off interesting I'll see how that works alright that's all any questions any you haven't gotten that's fine good if think of anything come around I'll be seeing you later thank I'm trying to check out same pressure and fast atrial fibrillation of uncertain underlying cause to exclude infection and electrolyte abnormality plan add on calcium magnesium phosphate number 1 number 2 chest x-ray number 3 packed x-ray given no trauma injury and persistent discomfort in the back number 4 increased regular sotalol number 5 once rate under a 100 consider arrhythmia nurse follow-up in af clinic