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Atrial fibrillation with decompensation — SCE Acute Medicine MCQ

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EasyAcute Cardiac PresentationsAtrial fibrillation with decompensationSCE Acute Medicine

A 74-year-old woman is assessed on the acute medical unit. She has new fast atrial fibrillation, pulmonary oedema and hypotension. Oxygen saturation is 88% despite supplemental oxygen and chest radiograph shows oedema. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: A — Perform synchronised direct-current cardioversion

Perform synchronised direct-current cardioversion is the best answer because AF causing haemodynamic compromise requires urgent electrical cardioversion. Give intramuscular adrenaline 500 micrograms is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Rate-control drugs can worsen shock or pulmonary oedema in unstable AF.

Reference: NICE NG196; Resuscitation Council UK ALS