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Question 183 · LEK · Atrial fibrillation

A 72-year-old patient complains of palpitations for the last 3 days, chest pain and dyspnea. He has never been treated cardiologically. HR 150/min, RR 100/60 mmHg, SaO₂ 96% while receiving oxygen therapy with the flow rate of 10 L/min. On auscultation there are crepitations at the base of both lungs. ECG shows: Indicate the optimal treatment apart from heparin administration:

Figure for the question
  1. A. maneuvers stimulating the vagus nerve, alternatively adenosine 6 mg iv in a bolus.
  2. B. amiodarone 300 mg iv for 60 minutes, and then amiodaron 900 mg iv in a 24-hour infusion.
  3. C. bisoprolol 5 mg iv.
  4. D. propafenone 2 mg/kg for 10 min.
  5. E. electrical cardioversion.
Hint

Identify the rhythm, estimate how long it has lasted, and note the heart failure signs that rule out some drugs.

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