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Atrial fibrillation rate control — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Atrial fibrillation rate controlUSMLE Step 3

A 78-year-old woman with persistent atrial fibrillation has palpitations. Heart rate is 118/min, blood pressure is 132/76 mm Hg, and ejection fraction is 60%. She has no preexcitation. Which of the following is the most appropriate next step in management?

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

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Correct answer: B — Start a beta-blocker or nondihydropyridine calcium channel blocker

Rate control with a beta-blocker or nondihydropyridine calcium channel blocker is appropriate in stable AF with preserved systolic function.

Reference: 2023 ACC/AHA/ACCP/HRS Atrial Fibrillation Guideline