A 59-year-old female presents to the clinic with complaints of persistent palpitations, mild shortness of breath, and occasional light-headedness over the past few days. She reports feeling fatigued and notes that her heart seems to beat quickly and regularly, especially at rest. She denies any chest pain but feels a sensation of "fluttering" in her chest.

The patient has a history of chronic obstructive pulmonary disease (COPD) and is a current smoker, with a 30-pack-year smoking history. She has no previous history of heart disease or hypertension. Her COPD symptoms have been stable, though she occasionally uses a bronchodilator when needed.

On examination, her blood pressure is 135/85 mmHg, and her pulse is regular but rapid, at 120 beats per minute. Cardiovascular examination reveals no murmurs, but her heart rhythm is fast and steady. An ECG shows classic sawtooth flutter waves, consistent with atrial flutter with a 2:1 conduction.

The patient is admitted for rate control, and anticoagulation therapy is initiated due to the risk of thromboembolism. She is started on a calcium channel blocker for rate control, and anticoagulation is prescribed to reduce the risk of stroke. A referral to cardiology is made for further evaluation and possible catheter ablation to manage the arrhythmia long-term. The patient is also counselled on smoking cessation to improve her overall cardiovascular and respiratory health.

She is discharged in stable condition with a plan for follow-up in the cardiology clinic to assess her response to treatment and discuss potential rhythm control interventions.