Briefly 79 yo F w/ a h/o CAD s/p RCA stenting BMS to mRCA [**3421**] and pLAD
   [**3423**], diastolic CHF (2 pillow orthopnea), 1+ MR, HTN, Hyperlipidemia,
   previous smoking history, and atrial fibrillation initially p/w cough,
   dyspnea.
   .
   Briefly, pt's symptoms began [**Month (only) 760**]. At that time pt was admitted
   with GI bleed, transfused and discharged without resolution of
   symptoms. Furthur workup noted bilateral atrial thrombi and
   anticoagulation was reinitiated. CTA did not show PE but was concern
   for small peripheral emboli as cause of dyspnea. Pt was had multiple
   PFTs, echos, CT scans and CXRs without definitive cause of dyspnea.
   Most recent PFTs on [**3432-12-27**] c/w restrictive ventilatory defect and low
   DLCO suspicious for interstitial pulmonary process (worsening). She has
   been followed by cardiology and pulmonology and is being treated for
   dCHF and reactive airway disease.
   .
   On current admission pt presented with cough, thought to be URI, rather
   than worsening of chronic dyspnea.  Current etiology considerations
   include CHF vs intrinsic pulmonary disease (infiltrative) vs embolic
   disease.
   In order to optimize cardic function with atrial kick, pt was
   pretreated with Sotolol and underwent TEE and cardioversion of afib on
   [**3433-1-11**].  After cardioversion, patient developed junctional HR to 45bpm
   with SBPs in 80s.  She was placed on dobutamine and HR increased to 80s
   (sinus vs antrial escape rhythm).  Off of dobutamine, HR and BP
   decreased with EKG demonstrated QTc of 700.