A man has new-onset atrial fibrillation of 5 hours' duration with a blood pressure of 70/40 mmHg and chest pain. What is the most appropriate treatment?
Answer and explanation
Correct answer: D. Synchronised direct current cardioversion
- Step 1: Shock and ischaemic chest pain are adverse features in a tachyarrhythmia. Step 2. An unstable patient needs immediate synchronised cardioversion, with anticoagulation given in parallel. Answer: Synchronised direct current cardioversion. Why not the others: Oral rate control is too slow and may drop the blood pressure further. Elective cardioversion after warfarin is for stable, long-standing AF. Digoxin acts too slowly in an emergency.
Practise more Cardiovascular medicine.
Free questions with an explanation for every one, and full timed UKMLA Applied Knowledge Test (MSRA-style single best answer) mock tests.
More Cardiovascular medicine questions
- A man has had 3 hours of crushing chest pain and the ECG shows ST elevation in leads V2 to V5. The nearest primary PCI centre can deliver tr…
- Which immediate drug should be offered to a patient with suspected acute coronary syndrome unless contraindicated?
- Which drug class has been shown to reduce mortality in chronic heart failure with reduced ejection fraction?
- A 72-year-old woman with non-valvular atrial fibrillation has hypertension and type 2 diabetes but no other relevant history. What is her CH…
- A 48-year-old man has non-valvular atrial fibrillation and hypertension, and no other risk factors. Which statement reflects NICE guidance o…
- Which anticoagulant is the appropriate choice for stroke prevention in a patient with atrial fibrillation and a mechanical mitral valve?