• Mr James Black is a 58 year old man who has been referred to the cardiology clinic from his GP.
• The GP’s referral letter states he has been troubled with breathlessness and palpitations that lasts for a few minutes to hours, a couple of times a week. He is obese, diabetic and hypertensive. His only medications include metformin 1g bd, atorvastatin 10 mg od and amlodipine 10 mg od.
• Included in the referral letter are some routine investigations including an NT-proBNP level which is 320 pg/mL and an ECG showing mild LVH and atrial fibrillation. A repeat ECG 5 minutes later showed sinus rhythm.
• The GP mentions he thinks Mr Black has heart failure and paroxysmal AF with a high CHADsVASc score and would like a further opinion and assessment.