Add: new atrial fibrillation management question for cardiology

questions/cardiology/acute/atrialFibrillation.md

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+---
+id: CARD013
+specialty: cardiology
+topic: arrhythmia
+difficulty: medium
+tags: [cardiovascular, afib, rate_control, anticoagulation]
+created: 2025-01-10
+lastUpdated: 2025-01-10
+---
+
+# New-Onset Atrial Fibrillation Management
+
+## Question
+A 68-year-old woman presents with palpitations and mild dyspnea for 2 days. Medical history includes hypertension and diabetes. Current status:
+
+Vital Signs:
+- BP: 142/88 mmHg
+- HR: 142/min (irregular)
+- RR: 20/min
+- SpO2: 95% on room air
+- Temperature: 37.0°C (98.6°F)
+
+Labs:
+- TSH: 2.1 mIU/L
+- K⁺: 4.2 mEq/L
+- Creatinine: 1.0 mg/dL
+- Troponin: negative
+
+ECG shows atrial fibrillation with rapid ventricular response, no acute ST-T changes.
+
+CHA₂DS₂-VASc score: 4
+
+Which initial management strategy is most appropriate?
+
+## Options
+| Option | Description |
+|--------|-------------|
+| A)     | IV metoprolol, heparin, plan for cardioversion |
+| B)     | Oral diltiazem, warfarin, follow-up in clinic |
+| C)     | IV digoxin, aspirin, cardiology consultation |
+| D)     | Oral metoprolol, direct oral anticoagulant, rate control strategy |
+| E)     | Immediate electrical cardioversion |
+
+<details>
+<summary>View Answer</summary>
+
+## Correct Answer
+D
+
+## Explanation
+This case presents new-onset atrial fibrillation requiring both rate control and stroke prevention:
+
+1. Key Assessment Points:
+   - Hemodynamically stable
+   - High stroke risk (CHA₂DS₂-VASc = 4)
+   - No immediate cardioversion indication
+   - No underlying thyroid disease
+
+2. Why Option D is optimal:
+   - Appropriate rate control strategy
+   - Modern anticoagulation approach
+   - Safe for stable patient
+   - Follows current guidelines
+
+3. Why other options fail:
+   - A) Urgent cardioversion not needed
+   - B) Warfarin less preferred than DOACs
+   - C) Digoxin not first-line, aspirin insufficient
+   - E) No indication for immediate cardioversion
+
+4. Management Priorities:
+   - Rate control
+   - Stroke prevention
+   - Identify/treat underlying causes
+   - Follow-up plan
+
+## References
+- AHA/ACC 2019: "Atrial Fibrillation Guidelines"
+- ESC 2020: "Management of Atrial Fibrillation"
+- CHEST 2021: "Antithrombotic Therapy in Atrial Fibrillation"
+</details>