Pneumonia and atrial flutter in a 71- year-old-man.

A 71-year-old man with a medical history of hypertension and 80 pack-years of tobacco smoking was presented with dyspnoea and coughof 3-week duration. He was tachycardic, with heart rate 127 beats per minute. ECG revealed atrial flutter. Chest x-ray showed right upper lobe consolidation consistent with pneumonia. Transesophageal echocardiogram (TEE)-guided cardioversion was ordered. The echocardiogram revealed normal biventricular systolic function without significant valvular disease. The left atrial appendage was enlarged but no thrombus was present. Doppler pulsed-wave interrogation of the right superior pulmonary vein (RSPV) demonstrated increased velocity (1.2 m/s, …