Jabba the Hut

You could smell the odour across the hall, a mix of muskiness and sweaty a-showerness. R poped out for a quick break, so he left me in charge and told me to see the patient.

It took the patient a good few seconds to gather enough strength to prop himself up from the chair and walk a few steps into the consultation room. He weighs more than 200kg, supports himself with two walking canes. He came in and plunk himself in the chair, relief from all that work. He told me that he is having atrial fibrillation, my eyes widen and my brow cringed.

"you are having AF? right now?!"

"yea, feel my pulse"

He's not joking, his pulses are irregularly irregular; it speeds up and slow down, weak and strong. My face goes pale. Lets hook you up to an ECG.

He has no chest pain, no dizziness, no claudication (he walks no more than 20 meters anyway), or ankle oedema. But he is short of breath (although he didnt seem too distressed, RR about 16), which severely limits his mobility. His palpitations worry me. He looks clamy and sweaty, no good.

The ECG showed first degree AV block (normal QRS, and a P for every QRS, but totally random PR intervals). Since its irregularly irregular you cant calculate the HR from PR interval, panicked, but then I remembered you can count the QRSs in 5 mins on a strip and work it out. I took the BP which was surprising low. HR 96 and BP 115/70, what is going on?

Whilst we are waiting for R to come back, he started telling me about all the cardiac drugs that he's been on. he complained how digitalis is limiting his exercise capacity, how spironolactone gave him man boobs, shrank his penis and reduced his libido. It suddenly reminded me of Jabba the Hut and his scantly clad slaves. his stomach drops as low as half way down his thigh, it'd be a mission to get all that fat out of the way to have sex.

When we are finally done and went back to the consultation room, R is as stoic as usual, so is the patient. The patient only wanted to find out if it is ok to go off one of his meds (among the long list that he has), and asked for a script which was promptly filled.

None of the palpitations nor SOB or AV block phased anyone, I was the only one freaked out and did a full cardio exam and ECG. But what do I know really?