"There are strings in the human heart that had better not be vibrated" - Charles Dickens On of the best things about rotating on the Cardiology service is that no patient is a surprise. I get told why I am going to see every patient on every consult. Even better, I get a chance to look up everything before meeting with my attending. You'd think that would help me answer all of his questions correctly when I get grilled, but no such luck. There's always more to know, and I try to use every trick in the book to remember it all. Anyways, during my first week on Cardiology I had over 4 consults for new onset atrial fibrillation in a single day. I assume that most of you know what A-fib is, but just in case: atrial fibrillation is an abnormal and often very fast heart rhythm. It is caused by disorganized electrical activity arising from the right atrium/SA node. A-fib is one of the most common heart conditions in the United States, with almost 10% of adults over the age of 65 diagnosed with the disease. Over the long term, people with untreated atrial fibrillation are more than 5 times more likely to have stroke. Luckily, A-fib can be treated. However, it's important to figure out what triggered your patient's arrhythmia. The image above is one of the better mnemonics for the causes of atrial fibrillation. We use it to guide what tests or orders we put in when a patient presents with acute onset of a-fib. Remember that rate control is important! What mnemonics do you use in the clinic? Let us know in the comments!