Atrial Fibrillation

A 68-year-old man with hypertension and diabetes mellitus presents with palpitations and dyspnea for 2 days. On examination, pulse is irregularly irregular at 110 bpm, BP 145/92 mmHg. ECG shows absent P waves, irregular RR intervals, and a ventricular rate of 115 bpm. Troponin I is normal. Echocardiography shows normal LV function and no structural heart disease. Which of the following is the most appropriate initial management?

A 62-year-old man with newly diagnosed atrial fibrillation (AF) and no structural heart disease presents to the cardiology clinic. He is haemodynamically stable, has a ventricular rate of 110 bpm, and requires rate control. Which of the following is the drug of choice for rate control in this patient?

A 58-year-old woman with permanent atrial fibrillation and a history of acute myocardial infarction 2 months ago (ejection fraction 35%) presents with persistent symptoms despite adequate rate control with metoprolol. She requires rhythm control. Which drug is the preferred choice for rhythm control in this patient?

A 62-year-old woman with newly diagnosed atrial fibrillation and no structural heart disease on echocardiogram is being evaluated for stroke risk. Which investigation is most appropriate to assess for occult left atrial thrombus before cardioversion?

A 58-year-old man with a 10-year history of hypertension presents to the emergency department with palpitations and dyspnea for 6 hours. His wife reports he has been increasingly fatigued over the past 2 weeks. On examination, his heart rate is 142 bpm and irregular, blood pressure is 128/82 mmHg, and respiratory rate is 22/min. Chest X-ray shows mild pulmonary congestion. ECG reveals an irregular rhythm with absent P waves and a ventricular rate of 130–150 bpm. Troponin I is negative. What is the most appropriate immediate management for this patient?