atrial fibrillation HR

Question

A 60-year-old patient, morbidly obese, with a history of HTN, HFredEF, and OSA presents to the hospital with chest pain and indicates that he feels his heart racing. Vitals reflect a HR of 140 contractions per minute and a blood pressure of 110-160 mmHg. 

An EKG is done and AF is diagnosed de novo for the first time. Answer the following three (3) questions.

Identify the risk factors this patient presents for the development of atrial fibrillation.

What would be the medication that you would recommend to get to control the heart rate?

What would be the medication that you would recommend to control the rhythm and convert the patient?

Answer 1

1. Risk factors, HTN, heart failure with reduced EF, and sleep apnea.
2. Control heart rate acutely with esmolol or metoprolol (IV) or diltiazem (IV)
3. First, decision needs to be made as to whether a rhythm or rather control approach is best. Assuming rhythm control (LESS common these days) a variety of drugs can be used, amiodarone, dofetilide, stotalol, flecanide to name a few.