Atrial Fibrillation

Multiple Choice

An 82 year old female with a known history of coronary artery disease is admitted to hospital with shortness of breath, cough productive of green sputum, and fever. She has right sided consolidation on her chest xray. An ECG shows new atrial fibrillation at a rate of 95bpm. Her blood pressure is 95/70mmHg.

What is your management?

• Start antibiotics

• Start antibiotics and anticoagulation with a NOAC

• Start antibiotics, bisoprolol and anticoagulation with a NOAC

• Start antibiotics and perform emergency DC cardioversion

Multiple Choice

A 68 year old man presents with palpitations and breathlessness that started one month ago. An ECG shows new atrial fibrillation at a rate of 130bpm. On examination he has crackles bilaterally on auscultation, and pitting oedema to just above his ankles.

An echocardiogram shows a moderately impaired dilated left ventricle.

You start anticoagulation. What else would you do?

• Start nebivolol 5mg. Start furosemide.

• Perform DC Cardioversion as an inpatient

• Discharge home on anticoagulation with a plan for outpatient DC Cardioversion. Start furosemide.

• Start Amiodarone and Bisoprolol for 6 weeks with a plan to review thereafter. Start furosemide.

Multiple Choice

A 75 year old male is admitted with shortness of breath for the past 3 weeks. He has a heart rate of 145bpm in atrial fibrillation. He is on warfarin for a metallic aortic valve.

What is your plan?

• Echocardiogram and Nebivolol.

• Echocardiogram and start Amiodarone.

• Echocardiogram, start nebivolol and discharge with outpatient cardioversion planned.

• Refer for ablation.