A 64 yo F w/PMHx sx for AF, COPD, HTN, hyperlipidemia who initially had
   an open ASD repair c/b sternal wound infection and post-operative AF in
   [**11-15**] treated with amiodarone. On [**2-20**], she was initially admitted
   through the ED with SOB and back pain, and was noted to have atrial
   fibrillation with RVR. A CTA demonstrating diffuse LAD and
   post-obstructive PNA concerning for malignancy. For her atrial
   fibrillation, she was started on diltiazem gtt, for which she was
   transferred to the [**Hospital Unit Name 42**] for monitoring. The atrial fibrillation was
   thought to be in the setting of a post-obstructive pneumonia, for which
   she was treated with antibiotics. She was then transferred to the floor
   later that same night on metoprolol 50 mg tid. While on the floor, she
   had a bronchoscopy performed which showed external compression of her
   left mainstem bronchus, and she had a biopsy/FNA performed, which
   showed large cell carcinoma. She was then readmitted to the [**Hospital Unit Name 42**]
   yesterday with atrial fibrillation with HR 130s, and was started on a
   diltiazem gtt.
   .
   In the [**Hospital Unit Name 42**], she was started on po diltiazem, which was rapidly
   uptitrated to 60 mg qid. She was called out this morning. Tonight, at
   8:30 pm, she was noted to have HR 160s, w/EKG c/w AF with RVR, for
   which she received metoprolol 5 mg IV x2, followed by diltiazem 10 mg
   IV x2 without conversion. She denies chest pain, SOB, tachypnea. She
   does note some diaphoresis and occasional palpitations.