Question

A 68-year-old with atrial fibrillation presents with chest discomfort, HR 160 bpm, BP 78/48 mmHg, cool extremities, and altered mentation. ECG shows narrow-complex irregular tachyarrhythmia without ST elevation. What is the next best step?

Accepted Answer

Immediate synchronized cardioversion

Answer

IV diltiazem bolus then infusion

Answer

Start IV amiodarone and observe

Answer

Begin heparin and arrange TEE-guided cardioversion later

Answer

Give adenosine to reveal flutter waves

Practice question

A 68-year-old with atrial fibrillation presents with chest discomfort, HR 160 bpm, BP 78/48 mmHg, cool extremities, and altered mentation. ECG shows narrow-complex irregular tachyarrhythmia without ST elevation. What is the next best step?