A 68-year-old woman with hypertensive heart disease develops atrial fibrillation with rapid ventricular response (130 bpm). Her BP is 90/60 mmHg and she is diaphoretic. What is the immediate management?
- A Immediate DC cardioversion ✓
- B IV diltiazem for rate control
- C IV amiodarone for rhythm control
- D IV digoxin for rate control
Correct answer: A. Immediate DC cardioversion
Explanation
Hemodynamic instability (hypotension, diaphoresis) due to AF with rapid ventricular response is an indication for immediate synchronized DC cardioversion regardless of duration. Cardioversion restores sinus rhythm and resolves hemodynamic compromise within seconds. IV rate-control agents (diltiazem, beta-blockers) are contraindicated in hemodynamically unstable patients and can cause further deterioration. Amiodarone may be used for pharmacological cardioversion in stable AF. Digoxin has slow onset of action.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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