QuestionSBA
QuestionChoice
This is incorrect. Beta-blockers are contraindicated in COPD. Therefore a rate-limiting calcium channel blocker is the medication of choice.
10027507
b
Bisoprolol
QuestionChoice
This is incorrect. The patient is stable and there is no clear onset time of the atrial fibrillation. If it were persistent the patient would need to be anticoagulated before cardioversion due to the increased risk of throwing off a clot. A rate-limiting calcium channel blocker is the medication of choice.
10027508
c
DC cardioversion
QuestionChoice
This is incorrect. This is usually considered in those with non-paroxysmal atrial fibrillation who are sedentary. It would not be used first line in this situation. A rate-limiting calcium channel blocker is the medication of choice.
10027509
d
Digoxin
QuestionChoice
This is the correct answer. The patient is suffering from fast atrial fibrillation (AF). The patient is stable and there is no clear onset time of their AF, thus it should be managed by rate control. As they have COPD beta-blockers are contra-indicated. Therefore a rate-limiting calcium channel blocker is the medication of choice.
10027506
a
Diltiazem
QuestionChoice
This is incorrect. This is used in rhythm control of fast atrial fibrillation if the onset time is <48hrs. As the onset time appears to be around 7 days in this case, the patient should be rate-controlled. Therefore a rate-limiting calcium channel blocker is the medication of choice.
10027510
e
Flecainide
Concept
Chapter
2693
5985
Class II anti-arrhythmics: Beta-blockers
Topic
169
Cardiovascular pharmacology
17899
A 57 year old male presents to A&E with palpitations and dizziness for the past 7 days. He denies any chest pain or loss of consciousness.

He has a past medical history of high cholesterol and chronic obstructive pulmonary disease (COPD), but is able to stay fit and active, and enjoys country walks.

On examination:
A - clear and patent.
B - chest clear, bilateral equal air entry, trachea central.
C - bilateral equal radial pulses, irregularly irregular pulse, heart sounds I+II+0.
D - BM 6.5, temperature 37.2.

Observations are as follows:
HR 125.
RR 20.
Saturations 95% on air.
GCS 15/15.
BP 138/84.

An ECG shows fast atrial fibrillation.

Which of the following is the first-line treatment?
a