A 59-year-old presents 6 hours after abrupt palpitations. Triage ECG shows atrial fibrillation at 148/min; BP is 132/78 mmHg and oxygen saturation is

Question

A 59-year-old presents 6 hours after abrupt palpitations. Triage ECG shows atrial fibrillation at 148/min; BP is 132/78 mmHg and oxygen saturation is 97%. He has no heart failure, no chest pain, and no prior stroke; creatinine is normal. What is the most appropriate next step?

Accepted Answer

Offer rhythm control with electrical cardioversion or procainamide after shared decision-making

Answer

Start thrombolysis for presumed embolic event

Answer

Admit for heparin infusion before any rhythm strategy

Answer

Give IV digoxin as the preferred rapid strategy

Answer

Discharge on aspirin without rhythm or rate treatment

Acute atrial fibrillation — RCPSC EM MCQ

A 59-year-old presents 6 hours after abrupt palpitations. Triage ECG shows atrial fibrillation at 148/min; BP is 132/78 mmHg and oxygen saturation is 97%. He has no heart failure, no chest pain, and no prior stroke; creatinine is normal. What is the most appropriate next step?