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HardEmergencyUnstable atrial fibrillationca-mccqe1ca-rcpsc-em

A 65 year old man presents with chest pain and shortness of breath. ECG shows atrial fibrillation with rapid ventricular response at 150 beats per minute. He is hypotensive with systolic blood pressure 80 mm Hg and has signs of pulmonary oedema. What is the most appropriate immediate management?

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