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Atrial flutter with 2 to 1 conduction — SCE Acute Medicine MCQ

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ModerateAcute Cardiac PresentationsAtrial flutter with 2 to 1 conductionSCE Acute Medicine

A 67-year-old man 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 regular tachycardia at 150 per minute with sawtooth flutter waves. What is the most appropriate next step in management?

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Correct answer: D — Rate control and anticoagulation assessment with cardioversion planning

The key discriminator is that regular tachycardia at 150 per minute with sawtooth flutter waves, which makes Rate control and anticoagulation assessment with cardioversion planning the single best answer. Optimise chronic medication and discharge is less appropriate because it does not address the dominant acute risk in the vignette; Call critical care for escalation would fit a different presentation or later stage of care. Start broad-spectrum intravenous antibiotics and Give targeted antidote or reversal therapy 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: NICE AF guideline