Atrial fibrillation and atrial flutter Quiz: Ace Your Exams
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A 76-year-old woman is seen by her primary care physician for a well-care visit. She has been doing well and has not seen her physician in over 2 years. She has no significant medical history and takes no medications. She has no shortness of breath, palpitations, dizziness, chest pain, or syncope. She has no family history of coronary artery disease. She does not use tobacco. Temperature is 37°C (98.6°F), blood pressure is 120/76 mm Hg, heart rate is 96 beats per minute and irregularly irregular, respiratory rate is 14 breaths per minute, and oxygen saturation is 99% on room air. The patient appears comfortable. A 12-lead electrocardiogram is obtained and shows an irregular rhythm with a rapid ventricular response, without the presence of P Waves, and with variable P-R intervals. Trans-thoracic echocardiogram (TTE) shows normal left ventricular (LV) function. Laboratory tests are shown below. Which of the following is the most appropriate next step in management?
| Laboratory value | Result |
| Hemoglobin | 13.5 g/dL |
| Thyroid-stimulating hormone | 2.1 µU/mL |
| Creatinine | 0.9 mg/dL |
| INR | 1.0 |
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