Typical exam stem
A 72-year-old patient presents with palpitations and an irregularly irregular pulse. Outline your assessment and management.
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
What ECG features define atrial fibrillation?
Progress is saved on this device. Use “Reset session” when you want a fresh attempt.
Confirm AF and assess immediate danger
Atrial fibrillation is diagnosed on ECG by an irregularly irregular ventricular rhythm with absent consistent P waves. The first decision is not the long-term drug choice; it is whether the arrhythmia is causing haemodynamic instability.
Features such as shock, ongoing myocardial ischaemia, severe pulmonary oedema or altered consciousness attributable to the tachyarrhythmia require urgent synchronised cardioversion.
Search for triggers and associated disease
- Infection, thyrotoxicosis, electrolyte disturbance, alcohol, pulmonary embolism and acute coronary syndrome.
- Hypertension, valvular heart disease, heart failure, obesity, sleep apnoea and chronic lung disease.
- Check ECG, electrolytes, renal function, full blood count and thyroid testing when appropriate; echocardiography helps define structural disease.
Organise the long-term answer
A useful framework is AF-CARE: manage comorbidities and risk factors, avoid stroke and thromboembolism, reduce symptoms with rate or rhythm control, and evaluate the patient repeatedly. Stroke prevention is a separate decision from symptom control. A patient whose ventricular rate is well controlled may still require anticoagulation.
For stroke prevention, use a validated risk approach and account for bleeding risk, kidney function, drug interactions and valvular disease. Rate control is often appropriate for stable patients, while rhythm control may be favoured when symptoms persist, AF is recent, heart failure is related to AF, or restoring sinus rhythm is expected to improve outcome.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.