Question:
A patient presents with irregularly irregular pulse and palpitations. He arrives 2.5 hours after symptom onset. There is no history of diabetes and BP is 160/100 mmHg. What is the next best step?
A patient presents with irregularly irregular pulse and palpitations. He arrives 2.5 hours after symptom onset. There is no history of diabetes and BP is 160/100 mmHg. What is the next best step?
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Stable atrial fibrillation usually needs rate control; unstable AF needs urgent synchronized cardioversion.
Updated On: May 14, 2026
- Control ventricular rate with verapamil
- Emergent cardioversion
- Transesophageal echo (TEE)
- Wait and watch
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The Correct Option is A
Solution and Explanation
Concept:
Irregularly irregular pulse suggests atrial fibrillation. In a hemodynamically stable patient, ventricular rate control is often the initial step.
Step 1: Identify rhythm.
Irregularly irregular pulse with palpitations suggests: \[ \text{Atrial fibrillation} \]
Step 2: Assess stability.
The patient is hypertensive but not described as hypotensive, shocked, unconscious or in pulmonary edema. Therefore, he is stable.
Step 3: Choose management.
For stable AF, rate control may be done using AV nodal blockers such as verapamil. Therefore, the next best step is: \[ \text{Control ventricular rate with verapamil} \]
Step 1: Identify rhythm.
Irregularly irregular pulse with palpitations suggests: \[ \text{Atrial fibrillation} \]
Step 2: Assess stability.
The patient is hypertensive but not described as hypotensive, shocked, unconscious or in pulmonary edema. Therefore, he is stable.
Step 3: Choose management.
For stable AF, rate control may be done using AV nodal blockers such as verapamil. Therefore, the next best step is: \[ \text{Control ventricular rate with verapamil} \]
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