A 66-year-old with AF for 20 hours has palpitations and mild dyspnoea. BP 134/78, no heart failure, no chest pain, normal electrolytes, and he has no

Question

A 66-year-old with AF for 20 hours has palpitations and mild dyspnoea. BP 134/78, no heart failure, no chest pain, normal electrolytes, and he has no anticoagulation contraindication. What is the most appropriate next step?

Accepted Answer

Use an ED cardioversion pathway with shared decision-making and anticoagulation assessment

Answer

Discharge without rhythm or rate plan because onset is under 48 hours

Answer

Admit to ICU for mandatory transoesophageal echo

Answer

Give thrombolysis before cardioversion

Answer

Start digoxin and defer reassessment for 72 hours

Recent-onset atrial fibrillation — RCPSC EM MCQ

A 66-year-old with AF for 20 hours has palpitations and mild dyspnoea. BP 134/78, no heart failure, no chest pain, normal electrolytes, and he has no anticoagulation contraindication. What is the most appropriate next step?