QuestionSBA
QuestionChoice
This would be correct if the patient was presenting with unstable AF causing haemodynamic compromise. However there is nothing in the stem to suggest that this is the case
33951
b
Make an urgent referral to A&E for synchronised DC cardioversion
QuestionChoice
As the patient has AF and a CHA₂DS₂-VASc of 2, anticoagulation should be initiated to lower the risk of a cerebrovascular event
33950
a
Start rivaroxaban 20mg OD
QuestionChoice
There is no role for aspirin in the management of AF absent some cerebrovascular event
33952
c
Start aspirin 75mg PO OD
QuestionChoice
This would be a possible option as a ‘pill in pocket’ strategy if the patient had paroxysmal AF. However there is nothing in the stem to suggest that this is the case
33954
e
Start flecainide acetate 50mg PO BD
QuestionChoice
This would be a possible option in rate-controlling fast AF or to manage symptoms such as palpitations
33953
d
Start bisoprolol fumarate 5mg PO OD
QuestionComment
Why wouldn't you rate control first? 

17353
QuestionComment
because her rate is normal so rhythm control needed

17585
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Serpiginous Serotonin
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Anterior WBC
QuestionComment
Why no rhythm control first for new AF?
38692
QuestionComment
I think its cos it doesnt say this is new AF and doesnt say how long its been going on for so assume anti-coagulation first
39896
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Myotonia Upright
QuestionComment
Also the rhythm is fine at 86bpm, no need to reduce it
41712
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Amnesia Defibrillator
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Cheryl Loh
QuestionComment
But she is taking escitalopram which is contra-indicated with rivaroxaban as they can both cause bleeding
44455
QuestionComment
Not an absolute CI, can just add a PPI to reduce risk of GI bleeding
44817
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test123
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Sarah
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2734
AF - warfarin appropriate to CHA2DS2VASc
Topic
9
Internal Medicine
6801
Case Presentation: A 53 year old woman who has recently moved to the UK from Vietnam attends an appointment for initial assessment after registering at her new GP. **PH** Takayasu arteritis, hypertension, generalised anxiety disorder. **DH** felodipine 10mg PO OD, escitalopram 15mg PO OD, ferrous fumarate 210mg PO BD, calcichew D3.


**O/E**

HR 86, RR 14, BP 134/92, Temperature 37.0°C, O2 99% RA. HS I + II + 0, lungs clear. Alert and comfortable at rest. She has an irregularly irregular pulse peripherally and centrally. This is not recorded on her most recent health documentation from her home country a year prior and she denies any troublesome symptoms.

**Investigations**

ECG: atrial fibrillation.

FBC, U&Es, LFTs and clotting studies all NAD.

Question: Select the most appropriate management at this stage.
a