Patient K., 24 years old, a student, was hospitalized to the cardiology department. Complaints of shortness of breath when walking up to 100 m, increased dyspnea in a horizontal position, palpitations, general weakness, edema of the legs. For 2 months he is noticing the shortness of breath and weakness. A week ago, there were irregularities in the work of the heart, and palpitations, since that time there has been a swelling of the legs. Life history: appendectomy in childhood, flu about 4 years ago. Objectively: the general condition is poor. The skin is pale. Swelling of the legs, feet. Peripheral lymph nodes are not enlarged. Dullness of percussion sound in the lower parts of lungs. Vesicular breathing, crepitant wheezing in the lower sections , respiratory rate - 26 per minute. Apical impulse in the VI intercostal space 3 cm outwards from the left midclavicular line. Borders of the relative dullness of the heart: right - 2 cm outward from the right edge of the sternum, upper - II intercostal space along the left midclavicular line, left - along the anterior axillary line. Muffled heart sounds, systolic murmur at the apex and at the V point of auscultation. The heart rhythm is wrong, heart rate is 122 beats per minute, blood pressure is 100/80 mm Hg. Art., average pulse - 105 per minute, irregular. The size of the liver according to Kurlov is 14 × 11 × 10 cm. Complete blood count: hemoglobin - 125 g / l, leukocytes - 4.0 × 10E9 / l, ESR 10 mm / h. Chest X-ray revealed cardiomegaly syndrome . Echo-CS: dilatation of the left and right ventricles, diffuse hypokinesis, ejection fraction - 28%. ECG: atrial fibrillation, HR - 132 in 1 minute. Questions: 1. Suggest the most likely diagnosis. 2. What changes in the myocardium are detected during histological examination in this disease? 3. List the ECG signs of atrial fibrillation. 4. Assign treatment to this patient. 5. Does the patient need to restore sinus rhythm?

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Patient K., 24 years old, a student, was hospitalized to the cardiology department. Complaints of shortness of breath when walking up to 100 m, increased dyspnea in a horizontal position, palpitations, general weakness, edema of the legs. For 2 months he is noticing the shortness of breath and weakness. A week ago, there were irregularities in the work of the heart, and palpitations, since that time there has been a swelling of the legs. Life history: appendectomy in childhood, flu about 4 years ago. Objectively: the general condition is poor. The skin is pale. Swelling of the legs, feet. Peripheral lymph nodes are not enlarged. Dullness of percussion sound in the lower parts of lungs. Vesicular breathing, crepitant wheezing in the lower sections , respiratory rate - 26 per minute. Apical impulse in the VI intercostal space 3 cm outwards from the left midclavicular line. Borders of the relative dullness of the heart: right - 2 cm outward from the right edge of the sternum, upper - II intercostal space along the left midclavicular line, left - along the anterior axillary line. Muffled heart sounds, systolic murmur at the apex and at the V point of auscultation. The heart rhythm is wrong, heart rate is 122 beats per minute, blood pressure is 100/80 mm Hg. Art., average pulse - 105 per minute, irregular. The size of the liver according to Kurlov is 14 × 11 × 10 cm. Complete blood count: hemoglobin - 125 g / l, leukocytes - 4.0 × 10E9 / l, ESR 10 mm / h. Chest X-ray revealed cardiomegaly syndrome . Echo-CS: dilatation of the left and right ventricles, diffuse hypokinesis, ejection fraction - 28%. ECG: atrial fibrillation, HR - 132 in 1 minute. Questions: 1. Suggest the most likely diagnosis. 2. What changes in the myocardium are detected during histological examination in this disease? 3. List the ECG signs of atrial fibrillation. 4. Assign treatment to this patient. 5. Does the patient need to restore sinus rhythm?Ww