A 74-year-old woman is presenting to her family physician’s office with complaints of shortness of breath on climbing stairs in her home.

• Atrial fibrillation with rapid ventricular response (102/min)
• Left ventricular hypertrophy (LVH) with QRS widening and repolarization abnormality

This patient had been known to be hypertensive for the past 10 years, poorly compliant to therapy. In retrospect, she admitted that “her heart had been racing” for at least a month. The family physician found her to be in heart failure. Her BP was 200/120 mm Hg, and atrial fibrillation was a new finding.