AF Patient Assessment & Clinical Evaluation 2 — Questions and Answers
Question 1: A patient with known AF presents with a resting heart rate of 128 bpm. Which clinical finding would most suggest rate control is inadequate?
- Irregular rhythm on auscultation
- Exertional dyspnea and fatigue at minimal activity (Correct answer)
- Absence of P waves on ECG
- QRS duration greater than 120 ms
Correct answer: Exertional dyspnea and fatigue at minimal activity
Symptoms of dyspnea and fatigue at minimal exertion indicate that the ventricular rate is inadequate controlled and is impairing cardiac output.
Question 2: When performing a structured clinical assessment for a new AF patient, which historical element is MOST critical for guiding anticoagulation decisions?
- Family history of arrhythmia
- Prior stroke or transient ischemic attack (Correct answer)
- Dietary sodium intake
- Current exercise tolerance
Correct answer: Prior stroke or transient ischemic attack
Prior stroke or TIA is a strong independent risk factor for thromboembolic events in AF and adds points to the CHA₂DS₂-VASc score.
Question 3: A 70-year-old man with AF, hypertension, and diabetes presents for evaluation. His CHA₂DS₂-VASc score is 4. What is the recommended next step?
- Aspirin monotherapy
- No antithrombotic therapy needed
- Initiate oral anticoagulation (Correct answer)
- Repeat ECG in 3 months before deciding
Correct answer: Initiate oral anticoagulation
A CHA₂DS₂-VASc score ≥2 in men warrants oral anticoagulation to reduce stroke risk.
Question 4: During auscultation of a patient with AF, the examiner notes an irregularly irregular rhythm. Which additional physical finding best supports hemodynamic compromise?
- S1 variable intensity
- Hypotension and diaphoresis (Correct answer)
- Absent S4 heart sound
- Clear lung fields
Correct answer: Hypotension and diaphoresis
Hypotension and diaphoresis indicate hemodynamic instability, which may require urgent rate control or cardioversion.
Question 5: Which medication class used in the assessment workup of AF can cause the condition as a side effect?
- Beta-blockers
- Thyroid hormone supplementation (Correct answer)
- ACE inhibitors
- Calcium channel blockers
Correct answer: Thyroid hormone supplementation
Excessive exogenous thyroid hormone can precipitate AF by increasing adrenergic tone and atrial automaticity.
Question 6: A 58-year-old woman presents with palpitations. Her 12-lead ECG shows absence of distinct P waves and fine irregular baseline. What is the ventricular response pattern expected in untreated AF?
- Regular at 60–100 bpm
- Regularly irregular
- Irregularly irregular (Correct answer)
- Regularly regular with dropped beats
Correct answer: Irregularly irregular
AF produces an irregularly irregular ventricular response because AV node conduction of chaotic atrial impulses is unpredictable.
Question 7: A clinician suspects paroxysmal AF in a symptomatic patient whose routine ECG is normal. What is the preferred next diagnostic step?
- Exercise stress test
- Ambulatory Holter monitoring for 24–48 hours (Correct answer)
- Echocardiogram
- Cardiac MRI
Correct answer: Ambulatory Holter monitoring for 24–48 hours
Holter monitoring captures intermittent arrhythmias that are absent during a standard 12-lead ECG snapshot.
AF Patient Assessment & Clinical Evaluation 2
A patient with known AF presents with a resting heart rate of 128 bpm.
Which clinical finding would most suggest rate control is inadequate?