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Atrial fibrillation with shock — SCE Acute Medicine MCQ

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ModerateAcute Cardiac PresentationsAtrial fibrillation with shockSCE Acute Medicine

A 29-year-old woman presents with acute chest symptoms with haemodynamic concern. Relevant history includes cardiovascular risk factors or structural heart disease. On assessment, haemodynamic findings and ECG changes are present. Investigations show rapid AF causes hypotension and pulmonary oedema. What is the most important immediate action?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Perform synchronised DC cardioversion

The key discriminator is that rapid AF causes hypotension and pulmonary oedema, which makes Perform synchronised DC cardioversion the single best answer. Give intravenous calcium gluconate immediately is less appropriate because it does not address the dominant acute risk in the vignette; Start acetylcysteine without delay would fit a different presentation or later stage of care. Perform synchronised cardioversion and Perform immediate decompression are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: https://www.resus.org.uk/library/2021-resuscitation-guidelines#acute-medicine-order-32-1