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Answer 2
  1. Perform stress test with nuclear imaging. Stress testing is contraindicated while the patient is still in significant CHF. The patient should certainly have cardiac enzymes drawn to rule out ischemic injury. Ischemic AF, although unusual, can occur. The patient, who has new CHF and multiple cardiac risk factors, is now subject to ischemic stress from a rapid rhythm and hypoxia. Given the history of a productive cough and fever in this immunocompromised patient, cultures should be drawn and empiric antibiotic coverage considered. Telemetry monitoring is certainly appropriate, because he may revert to AF again. Electrolyte monitoring with aggressive replacement of potassium and magnesium is essential to decrease the risk of ventricular dysrhythmias in a patient with CHF undergoing diuresis. Echocardiography will provide much information about the presence of structural heart disease, LV and valvular function, pulmonary pressures, and LV hemodynamics.

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