AF Patient Management 2

Question 1

A patient with AF and a CHA₂DS₂-VASc score of 3 is intolerant to warfarin. What is the most appropriate next step?

Accepted Answer

Initiate a direct oral anticoagulant (DOAC)

Answer

DOACs such as apixaban, rivaroxaban, or dabigatran are preferred alternatives when patients cannot tolerate warfarin.

Question 2

Which finding on a 12-lead ECG is most characteristic of atrial fibrillation?

Accepted Answer

Absence of distinct P waves with irregularly irregular rhythm

Answer

AF produces an irregularly irregular ventricular response with absent, organized P waves replaced by fibrillatory baseline activity.

Question 3

A 72-year-old with AF is started on amiodarone for rhythm control. Which monitoring is most critical at follow-up?

Accepted Answer

Thyroid function tests, liver enzymes, and pulmonary function

Answer

Amiodarone has significant organ toxicity affecting the thyroid, liver, and lungs, requiring periodic monitoring of all three systems.

Question 4

When is elective cardioversion of AF generally safe without transesophageal echocardiography (TEE) guidance?

Accepted Answer

When AF duration is confirmed less than 48 hours

Answer

AF of less than 48 hours duration carries a low thromboembolic risk, allowing cardioversion without mandatory TEE to rule out atrial thrombus.

Question 5

A patient with AF develops a sudden drop in blood pressure and signs of hemodynamic instability. What is the immediate management?

Accepted Answer

Synchronized direct current cardioversion

Answer

Hemodynamically unstable AF requires immediate synchronized electrical cardioversion regardless of anticoagulation status.

(AF) Atrial Fibrillation Certification Practice Test