doc_clotaire
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NSIM in unstable ( low BP ) AF -------------------A. Electrical cardioversion
but if AF is more than 48 hrs cardioversion is not recommended until sufficient anticoagulation is achieved so I would go for
E. Low-Molecular-Weight heparin
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| sprint123
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I am afraid to differ clotaire----LMW heparin in acute AF without symptoms doesn't fit is --i think! Maybe better option will be chemical control with IBUTILIDE since electrical cardioversion is Contraindicated as you mentioned!
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| sridevibandaru24
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Atrial fibrillation of >2days duration. we cant do electical cardioversion. First is rate control with beta blockers then sinus rythm conversion with Antiarrythmics and after giving 6wks of anticoagulation, electrical cardioversion.
please correct me if i am wrong
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| ssrpk
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yes it should be metoprolol then LMWH
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| cirus
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If i remember correct Conrad Ficher clearly stated that a pt with any tachy-arythmia & unstable should be cardioverted, He also stated Lightheadedness as one of the criteria of compromise so Cardioversion is the ans A
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| doyoudig
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where did u get this question from? thx
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| doyoudig
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I did read somewhere that palpitaions is not a sign of Unstabilty but Syncope, Angina and SOB are as well as of course Syst < 90 and Diast < 60.
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| Ivonne
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I will go for metoprolol but keeping and eye in his blood pressure and simultaneously with IV heparin ASAP( Is that Cr: 2.3 result of a thromboembolic complication?).
But I am not sure.....
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| doyoudig
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I think I will agree w/ docclaire, in order to prevent stroke emboli she should be put on LMWH 1st then take care of the Rate
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| arlete
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I would give Metoprolol. He is not unstable, and I would fully anticoagulate with warfarin.
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| dr in trouble
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I think the answer should be Ibutilide as pt is not unstable bcoz BP is >90.
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| mjl1717
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my semieducated guess is low molecular weight Heparin.
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| prathapdoctor
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I think the patient is not unstable, he is in AF, of more than 48hrs duration, so I would go with Rate control first by giving metoprolol.
then i will give anticoagulation therapy to try for electrical cardioversion after 6wks under it.
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| ssrpk
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so here comes the new dilemma, as UW and other medicine review books states that both anti-coagulation and rate contro will be given priority over rhythm in any patient whoz stable and has atrial tachyarrhythmias, UW has explained that too, but did'nt ask for a choice between them.....
besides guessing, can any one explain the logic behind selecting rate control or anticoagulation as the first step in managment.? as both will be required without any waiting!
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| arlete
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Ibutilide and amiodarone are given for cardioversion, don't give them for more then 48 h arrhythmia. Anticoagulate first, or do a TEE to be sure there's no thrombi (start heparin during TEE).
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| young_doc
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I wouldn't considering him to be unstable.
Rate controle first --> Metoprolol.
Anticoagulate next --> LMWH or Unfractionated Heparin
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| virgola82
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Young_doc is right the right answer is metoprolol. In such a patient rate control comes first because 132/min is really a high freq rate, than anticagulation would be done and eventually rythm control maybe with ibutilide. I am sorry I have been out for few days and couldn't post the right answer earlier
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