A 75-year-old man with hypertension and no prior cardiac history presents with acute palpitations and dyspnea. Vital signs: BP 78/46 mm Hg, HR 160/min, RR 28/min, SpO2 88% on room air. ECG reveals atrial fibrillation with rapid ventricular response. Troponin is normal. Chest X-ray shows mild pulmonary edema without acute coronary findings. He denies chest pain. Which of the following is the best next step in management?

  1. A)Procainamide infusion
  2. B)Observation only
  3. C)Oral metoprolol
  4. D)Immediate synchronized cardioversionGABARITO
  5. E)Intravenous adenosine

Explicação

Hemodynamic instability in atrial fibrillation requires immediate synchronized cardioversion. Hypotension indicates that delaying treatment for rate control or rhythm assessment would be unsafe. Ver explicação completa e trilha adaptativa →

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