Cardiovascular
Atrial fibrillation
Split an unstable rhythm from a stable one, and keep stroke prevention as its own decision.
Educational only. A local note appears only when a public source is attached. This page does not say that one exam, or training in one country, makes you eligible to practice in another.
Global core
Atrial fibrillation is an irregularly irregular atrial rhythm. An unstable patient needs immediate synchronized cardioversion. A stable patient needs a rate or rhythm plan and a separate decision about stroke prevention. Slowing the rate does not, by itself, prevent stroke.
What stays the same
- Instability means shock, ischemia, or pulmonary edema, not a fast rate alone.
- Rate control does not prevent stroke.
- Aspirin is not a substitute for anticoagulation when stroke prevention is indicated.
- Recognize. Palpitation, breathlessness, or an irregular pulse found by chance.
- Reason. Look for instability, a reversible trigger, and the risk of thromboembolism.
- Prioritize. Shock, ischemia, and pulmonary edema outrank elective rhythm control.
- Act safely. Cardiovert if unstable. If stable, control symptoms and decide on anticoagulation as its own question.
Local adaptation
No sourced local note is attached to this topic. That is not a statement that every country manages it the same way. The shared principle above is what this beta is willing to teach.
Exam lens
Unstable versus stable, and the next action rather than a list of drug names.
Original case · shared decision
The lens above is how that exam usually frames the medicine. This case stays on the shared decision. Not an official examination item.
A 76-year-old man has had palpitations for six hours. He is speaking, blood pressure is 128/76 mm Hg, the lungs are clear, and there is no chest pain. The ECG shows atrial fibrillation at 130/min. He has never been anticoagulated. What is the best immediate framing of his care?