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Atrial fibrillation — MCCQE Part 1 MCQ

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ModeratePalpitationsAtrial fibrillationMCCQE Part 1

76-year-old woman with hypertension presents with irregular palpitations and mild dyspnoea. ECG shows atrial fibrillation at 130/min; she is haemodynamically stable. Which of the following is the most appropriate next step?

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Correct answer: B — Assess stroke risk, control rate and start anticoagulation unless contraindicated

Assess stroke risk, control rate and start anticoagulation unless contraindicated is best because older age and hypertension give high thromboembolic risk in atrial fibrillation. Discharge after a single normal initial test is suboptimal because early cardiac disease can be missed by one isolated result; Arrange routine cardiology review without acute risk stratification is suboptimal because routine referral is too slow for a potentially unstable presentation; Give reassurance because the patient is young or previously well is suboptimal because age alone does not exclude serious cardiovascular disease; Treat only the symptom and omit ECG or biomarker-based assessment is suboptimal because cardiac presentations require objective assessment when suggested clinically. Stroke prevention is usually more important than restoring sinus rhythm immediately.

Reference: CCS Atrial Fibrillation Guidelines