Cardiology by DR-KIM

 In a patient with Mitral stenosis which of following can occur  Exercise can induce acute
pulmonary edema.
 LDH and CKMB found together on  2nd day.
 Normally LDH_2 is elevated then LDH-1 but in MI there is LDH-1 flip and LDH_1 become greater .
 LDH-1 is more important in LDH isoenzymes to indicate MI.
 Baroreceptors are located in tunica adventitia of large vessels.
 A person stand from sitting position heart rate increase due to  Decrease firing rate from
baroreceptors . (Decrease venous return  Decrease stretch on baroreceptors  Decrease
firing  Activation of sympathetic response and heart rate increases).

 Digitalis effect on heart  Positive Ionotropic (contractility ).

 About 75% of myxomas are found in  Left atrium.
 Most common cyanotic heart diseases immediately after birth and also in infant of diabetic
mother is TGA.
 Most common cyanotic heart diseases is in neonates is TGA after neonatal period  TOF as
TGA is not compatible with life unless intervention is done .
 Most common Acyanotic heart diseases is VSD
 Most common congenital heart disease is VSD
 Most common Acyanotic heart disease in adults is ASD
 Auto regulation is not seen in  Skin.
 Turbulence is increased by increase velocity and decrease viscosity.
 Longest phase of cardiac cycle is  Diastasis or reduced ventricyular filling .
 The phase of cardiac cycle mosr effected by heart rate is  reduced ventricular fillin.
 Angina like symptoms more likely to occur with --. Aortic stenosis.
 First sign of hypertensive retinopathy  Arteriosclerosis.
 Giant A waves are seen In tricuspid stenosis ,
 Cannon A wave are seen in complete heart block .
 A waves are absent in atrial fibrillation.
 Decrease pressure in carotid sinus leads to  tachycardia.
 Post MI arrhythmias treated by class Ib anti-arrythmics (lidocaine).
 Class IC antiarrythmics are contraindicated in post MI arrhythmias.
 Arm brain circulation ocuurs in  10-20 seconds.
 Cerebral blood flow upper and lower limit is  50-150 mmhg.\
 Organ having highest Atriovenous difference is  heart and Lowest is  kidney .
 Faty acid is primary source of energy for  stroke work.
 Mitochondria are more in cardiac muscles then skeletal muscles.
 Most posterior part of heart is  Left atrium.
 Fixed splitting is seen in  ASD.
 Absolute refractory period for cardiac muscle is  200 ms.
 Single breath nitrogen used to measure anatomical dead space.
 Common cause of sudden death after myocardial infarction is  arrhythmias.
 Dysphagia cause enlargement of which part of heart  left atrium .

 Artificial pace maker is placed in  right ventricle.

 Pulseless disease  takyasu arteritis.
 Prinzmetal angina shows  transient St elevation rather then st depression.
 Artery occlusion most commonly occur in MI is  LAD.
 WPW are more prone to  SVT.
 Pulmonary cappilary wedge pressure approximate which pressure?  Left atrial pressure.
 Most common cause of thoracic aortic aneurysm is  Hypertentrion .
 Most common cause of abdominal aortic aneurysm is  Atherosclerosis.
 V1,V2  anterioseptal and V3 , V4  Anterioapical .
 Fetal circulation has more oxygen in inferior vena-cava then superior venacava.
 PR depression is more specific for  Pericarditis.
 Libman sac endocarditis primarily effects  Mitral and aortic valve.
 Highest aortic pressure occurs during slow ejection phase .
 Lowest aortic pressure occurs during isovolumetric contraction.
 Greatest increase in ventricular volume occurs during rapid ventricular filling.
 Greatest decrease in ventricular volume occurs during rapid ejection
 Ecg segment showing ventricular filling is  PR interval.
 Main blood supply of interventricular septum is  anterior interventricular artery (LAD).
 Ecg wide QRS complexes with heart rate of 25 . where is pace maker  Purkinji fibers.
 Pace maker in AV node Heart rate is  40 to 60.
 Pace maker in purkinji fibers or ventricle then heart rate is  20 to 30.
 Lowest prepolariozation action potential  SA node,
 A woman living at a hill station has had an uncomplicated pregnancy. She is brought to the
hospital at the onset of labour. An ultrasound scan is performed which shows no fetal
abnormality. The baby can still have which of the following conditions  PDA.
 Carotid sinus give response to  Change in blood pressure. Low BP  decrease firing , and high
bp  rapid firing.
 Anterior 2/3rd of ventricle is supplied by LAD (LCA) and posterior 1/3rd of ventricle is supplied by
PDA (RCA).
 In infant dehydration is assessed by palpating  bregma( anterior fontanelle).
 Brainbridge reflex increases heart rate as a response to increase blood volume.
 Ecg shows Flat T waves and prolong PR interval  Hypokalemia.
 Hypocalcemia prolong QT interval .
 Hypercalcemiua  shortens Qt interval.
 35 year old female case of mitral stenosis and atrial fibrillation now presented with stroke , likely
cause is  Embolism.
 The irreversibly damaged cardiac myocytes will show signs of contraction band necrosis (the
hallmark of myocardial  Reperfusion injury.
 Adenosine has  negative ionotropic effect drug of choice in  SVT.
 Type A personality has increase risk of CHD due to  Increase stress.
 Saturation of CO2 is measured by  Capnometer.
 Sternocostle surface of heart is formed by  Right ventricle.
 Right border of heart is formed by  Right atrium .
 Right border of heart on xray  SVC plus right atrium .
 Base of heart by  left atrium.
 Apex  left ventricle.
 Diaphragmatic surface of heart is formed by both ventricles but mainly by  left ventricle.
 If right coronary artery is occluded distal to right marginal artery which part of heart will be
affected  AV node.
 Plateau phase of cardiac action potential is due to  Calcium ions.
 Bundle of his is supplied by RCA.
 Anemia leads to  High out-put cardiac failure.
 Hepatoma  early compress portal vein ( no signs of dependent edema )
 Hepatoma  late compress IVC ( dilated abdominal veins and dependent edema)
 Indepenet atria and ventricular contraction  Complete heart block ( AV nodal block).
 On standing suddenly  venous compliance increases.
 Venous drainage of heart is ,mainly by  coronary sinus.
 Child with cyanotic spells and clubbing  TOF.
 A portal anastomosis is capillary network between two  veins.
 Highest pulse pressure is in  Dorsalis pedis artery > femoral > renal artery i.e Down stream
arteries,
 First heart sound will be louder in  Short PR interval.
 Cardiogreen dye is used to measure cardiac out put .
 Which ion will help the patient who has depressed cardiac activity due to citrate  calcium ions,
 Valve damage , thrombosis , bacteremia and perforation is sequence of  endocarditis.
 Pulmonic valve opens at pressure of  8 mmhg and aortic at 80 mmhg.
 Long term BP control  RAAS
 Most rapid response to control BP is  baroreceptiors .
 Most potent response to control BP is  CNS ischemic response .
 Maximum feed back gain to control BP is  RAAS system.
 Pulse pressure is increased in  Aortic regurgitation.
 Wpw presents with  short PR interval.
 A patient presented to ER with moderate hemorrhage what will ne present  Postrul dizziness.
 Which of the following increase venous return to heart  Calf muscle contraction,
 V/Q ratio increases in pulmonary embolism ( dead space).
 Systolic duration is 3 sec if heart rate is 75 , what will be systolic duration if HR is 225  1
second (225/75 = 3 so 3/3= 1).
 Immediate body response to increase temperature is  cutanious vasodilatation.
 Venous return is measured by  preload (EDV).
 After load  MAP.
 Factor determining TPR index  diastolic pressure.
 Semilunar valves open during which phase of cardiac cycle  rapid ejection phase.
 The major neuroendocrine response that will occur in patient during surgery to  bleeding,
 Twitching of muscles , carpopedal spasm and ecg show s prolong QT interval  hypercalcemia.
 Earliest sign of successful resuscitation after hypovolumic shock is  Increase in urine out-put .
 Increase in stroke volume will decrease  ESV.
 Hypoglycemia  prolong QT interval.
 Dicrotic notch  closure of aortic valve.
 In 3rd degree heart block atria beat independently of ventricle.
 Most potent response to massive hemorrhage is  CNS ischemic response.
 Vagal stimulation of heart increases  pr interval.
 Normal ECG does not record electrical activity of  SA node.
 Cushing triad  Raised ICP , bradycardia , hypertentrion.
 Cardiac tissue consume maximum oxygen during  increase heart rate .
 A patient presented to CCU with sudden onset of unconsciousness ECG was done that showed
HR of 300/ min and sawtooth waves with 3:1 P and QRS ratio what is diagnosis  Atrial flutter.
 Which of the following is the immediate effect of RAAS system  arteriolar constriction.
 Clonidine decreases blood pressure by acting on alpha 2 receptors in CNS.
 Has Wpw shows  wide QRS complex.
 Coronary sinus  no vlaves.
 Common cardiac defect seen in congenital rubella syndrome is  PDA.
 Incisura or dicrotic notch is seen at  aortic valve closure.
 AV nodal delay ensures  ventricular filling.
 Progressive prolongation of PR interval followed by drop beat  MObitz tye 1.
 Immediate potent action of AT2  vasoconstriction.
 DOC for atrial fibrillation rhytm control  flecainide > amoidarone .
 Hemodynamically unstable atrial fibrillation what to do  DC cardioversion.
 Atrial repolarization is evident in which type of heart block  3rd Degree heart b;lock
 Which of the following is last to return after hemorrhagic shock  Number of RBCs perunit
volume.
 Conduction speed is slowest in  SA node and AV node .
 Pulmonary arterial pressure increases by increase in  Hypoxia.
 During exercise coronary blood flow increases due to  local metabolites.
 Which of the following decreases blood flow to the brain  hyperventilation.
 Efferent of Bainbridge reflex  Vagus nerve,
 In atrial flutter heart rate is between 200 to 350 bpm.
 In complete heart block fainting occurs because of prolong interval in which ventricles fail to
contract.
 In ECG waves are predominantly negative in AVR.
 Distribution of blood is mainly regulated by  arterioles.
 In strenuous exercise which of the following is not increased  TPR.
 Cardiac out put main determinant is  venous return.
 The work done by left ventricle is greater then right ventricle because in left ventriclre there is
 greater after load.
 What is normal ejection fraction valve  65%.
 RMP of heart is more dependent on  K .
 Ventricles receives impulses directly from  purkinji fibers.
 Pressure difference between ventricle and aorta is minimum during  left ventricle during
systole.
 Greatest pressure fdrop in arterioles is because of  highest resistance in arterioles,
 Isoelectric line on ECG during which complete depolarization of ventricle occurs is  ST
segment .
 Largest reservoir of blood  veins .
 Largest total cross sectional area  capillaries,
 Electrical potential on ECG is due to  Partially depolarized state .
 Sympathetic system decreases AV nodal delay , Parasympathetic system increases AV nodal
delay.
 Blood flow to tissues is maintained by  MAP.
 Atrial fibrillation  absent P wave and irregular RR interval .
 Most common cause of death in Rheumatic fever is  Myocarditis.
 Cardiovascualr change is Geriatric is  systolic hypertention.
 Cardiac tissue is more vulnerable to arrhythmias  when action potential is about to end.
 Increase heart rate while standing is mediated by  decrease firing of baroreceptors.
 Most common cause of HTN  Idiopathic.
 Athletes have high resting cardiac out put due to high  Stroke volume.]
 Maximum pressure is dissipated at  Arteriocapillary junction.
 Pulsus peradoxus is seen in  cardiac temponade.
 Coronary blood flow is increased by  Adenosine.
 At which point on ECG more calcium ions enter ventricular system  ST segment .
 What is differentiate septic shock from hypovolumic shock  increase in cardiac out put .
 Location Of Abdominal Aortic Aneurysm (AAA)
► → AAA occur most commonly below Renal arteries (L2)
► → → Below L2 Most common location for AAA B/W Renal Arteries(L2) & IMA (L3)
► → Most accurate answer would be L2-L3 interspace . Because beyond L4 There is no
abdominal Aorta .
 Posteriolateral wall MI artery involved is  LCx artery.
 High pressure in coronary artery is seen in  start of Diastole.
 First sign of irreversible damage to cardiac muscles is  Contraction Band necrosis.
 Most common cause of endocarditis in IV drug abusers is staph aureus.
 A child has mouth ulcers and hand and foot lesions with coronary artery aneurysms could have
 Kawasaki.
 An elderly patient has temporal headache and jaw claudication , artery biopsy will show 
Giant cells.
 A febrile patient has anemia and weight loss for several weeks , O/E there is splenomegaly and
splinter hemorrhages ,and new onset of murmur ,what investigation will you do to diagnose 
Blood culture (infective endocarditis)
 Bicuspid aortic valve is associated with which of the following conditions  Coarctation of aorta
and aortic dissection
 Treatment of infective endocardiitis  penicillin and gentamicin
 Anticoagulant used in MI is  Enoxaperin.
 A patient died with in 24 hours of MI , most likely he developed  Arrythmias.
 Which part of kidney is more prone to damge in hypovolumic shock  PCT
 Berger disease is most commonly related to  smoking .
 Patient with transmural infarction suddenly collapsed in bathroom after 8 days most likely cause
is  Cardiac temponade.
 Pulmnonary infdarction is due to  small artery emboli.
 In patient congestive heart failure is worsening due to  Na and water retention.
 Delayed closure of pulmonic valve is seen in  inspiration.
 An old male known case of COPD and chronic smoker presented with raised JVP ,Bilateral pedal
edema , tender right hypochondrium ( congestive hepatopathy) and Bilateral crackles in lung ,
what is diagnoisis  Cor-Pulmonale.
 Low voltage QRS complexes are seen in  Old recurrent MI.
 Which of the following can occur in scurvy  hemopericardiuym
 Drug of choice in prinzmetal angina is  CCBS ( nefidipine)
 Low voltage complexes on ECG in burn patient  Hyponatremia.
 Pericarditis seen with deranged RFTs (Uremia)  Fibrinous.
 Ulcers seen in hypertention are called  Martorell .
 Patient with damaged heart valves developed fever and splinter hemorrhages what is the cause
 Strep viridians.
 Severity of Mitral stenosis is clinically assessed by  length of diastolic murmur.
 After 5 days of MI which type of cells will be abundant in cardiac tissue  Macrophages.
 True regarding carcinoid heart disease  thickening of Tricuspid valve,
 Pancystolic murmur and cyanosis is seen in 5 month baby what is the cause  VSD.
 Microaneurysim is first sign of  Diabetic retinopathy .
 Which of the following occurs in PDA  Increase pulmonary resistance.
 Factor related to coronary artery disease and inhibit fibrinolysis  LDL _C.
 Which of the following is not feature of PDA  ECG is usually abnormal.
 Most common cause of infective endocarditis in patient with prosthetic valve Staph
epidermidis.
 The condition in which pulmonary trunk fails to divide is called  Trucusarteriosus.
 Which of the following does not regress with time  Portwine stain.
 Characteristic retinal changes seen in hypertention is  AV nipping .
 On 3rd day of myocardial infarction what will be seen in cardiac tissue necrosis with
neutrophills and macrophages.
 Polyarteritis nodiosa is associated with  HBV.
 IHD with or without MI features is called  Unstable angina.
 Most common anomaly of great vessels is  PDA.
 Libman sac endocarditis involves  mitral and aortic valve.\
 Cocksackie B virus can cause  Myocarditis.
 coatrctation of aorta is seen just after subclavian artery.
 Pansystolic murmur is seen in patient recovering from MI , Diagnosis valvular prolapse or
ventricular septal ruptiure.
 Postmortem, thrombus is characterized by  current jelly or chicken fat appearance .
 Line of zahn is used to differentiate between arterial and venous thrombus .
 Line of zahn are seen in  Coraline thrombus,
 Subacute endocarditis  strep viridians.
 Acute endocarditis  staph aureus.
 Emboli first lodge iin  pulmonary artery .

 Myocardial infarction
 Gold standard in first 6 hours ECG ..
  Recurrent MI ______CK_MB
 Appear late Go late (Lazy) _____ LDH ..
 Most sensitive Trop T.
 At which time u will find CKMB and LDH together_______ 2 nd day
 Most specific ______ Trop I.
 Rising of Myoglobin is the first marker of myocardial injury.
 Troponins (more specific) ,Ckmb (moderate specific) , Myoglobin (non_specific).
 LDH 1 is more specific then Total LDH.
 Enzyme used to diagnose MI in patient on dialysis is ______Troponins.
 Initially diagnosis of Mi is made by History and ECG and Enzymes appear later.

MCQS
A 35 year woman suffers severe chest trauma, she is unconscious and her BP drops rapidly.
She sustained a tear in one of the pulmonary vein at the point at which the vein enters the
heart. Patient blood will be present into which of the following space.
A. B/w Epicardium and parietal pericardium
B. B/w Fibrous pericardium and parietal pleura
C. B/w Myocardium and epicardium
D. B/w Parietal pericardium and the fibrous pericardium
E. B/w Parietal pleura and visceral pleura
ANS A
To decrease EDV what should be increased?
A. Contractility
B. HR
C. Ventricular relaxation
Answer  B
Which of the following is Both inotropic and chronotropic ?
A.Glucagon
B.Digoxin
C.Phenyleprine.
Answer  A
In systemic amyloidosis the site of deposition in heart is?
A) Coronary vessels.
B) Sub-endocardium.
C) Aortic valve cusp.
D) Mitral valve cusp.
E) AV node.
Answer  B
Deep inspiration leads to ??
A. Increase cardiac output
B. Increase pulmonary complaince
C. Decrease venous return
D. S1 split
Answer  B
Oxygen hemoglobin dissociation curve is shifted to the left by:
a) Fall in pH.
b) Fetal hemoglobin.
c) Increased body temperature.
d) Increased PCO2.
e) Increased 2:3 diphosphoglycerate
Answer  B
Which of the following tumour can arise in the heart?
a) Pheochromocytoma.
b) Melanoma.
c) Heamangiopericytoma.
d) Rhabdomyosarcoma.
e) Ewing's sarcoma.
Answer  D
Which factor determine by TPR index.
A.Diastolic pressure.
B . MAP
Answer  A
A 42 years old man is brought to emergency with severe chest pain for the last 12 hours. Which
one is the most specific test to confirm the provisional diagnosis of myocardial infarction:
a) Myoglobin.

b) LDH.
c) Troponin “t”.
d) CK mb.
e) CPK.
Answer  C
Which of the following has been shown to prolong life in a CCF-patient but has a negative
inotropic effect on cardiac contractility:
a) Carvedilol.
b) Dobutamine.
c) Enalapril.
d) Digoxin.
e) Furosemide.
Answer  A
Systolic blood pressure is highest in
A. Pulmonary artery
B. Cerebral arteries
C. Renal artries
D. Brachial artries
Answer  C
Broadening of the QRS complex of the electrocardiogram is typically produced following
administration of:
a) Lidocaine.
b) Quinidine.
c) Nifedipine.
d) Propranolol.
e) Verapamil.
Answer  B.
The ST segment occurs during which phase of the myocardial action potential?
a) Phase 1.
b) Phase 2.
c) Phase 3.
d) Phase 4.
e) Phase 5.
Answer  B
Explanation  Phase 2 corrosponds to  to ST segment, Phase 4 to  TP segment and Phase 3 to 
T wave.
Most Common cause of infarction of visera
A. Atheroma
B. Thrombosis
Answer  B
U wave in ecg due to?
A-SA node repolarization
B-Av node repolarization
C-Septum depolarization
D-Slow repolarization of papillary muscle
Answer  D.
Fallot’s tetrology is characterized by:
a) Patent ductus arteriosis.
b) Pulmonary stenosis.
c) Overriding of pulmonary trunk.
d) Atrial septal defect.
e) Left ventricular hypertrophy
Ans  B
Stab wound in the anterior surface of the heart can injure:
a) The coronary sinus.
b) The great cardiac vein.
c) The mitral valve.
d) The left atrium.
e) The atrioventricular node
Answer  B
Which artery is involved if a patient has an anterior wall myocardial infarction?
a) Right coronary artery.
b) Pulmonary trunk.
c) Left circumflex artery.
d) Marginal artery.
e) Left anterior descending artery.
Answer  E.
Following vein drains directly into the cavity of the right atrium:
a) Great cardiac.
b) Anterior cardiac.
c) Middle cardiac.
d) Oblique vein of the left atrium.
e) Pulmonary.
Answer  B.
The pain from pericardium is frequently referred to ??
a) The shoulder.
b) Medial side of the arm.
c) Medial side of the forearm.
d) Hypogastrium.
e) Epigastrium.
Answer  A.
A young male patient was subjected to open cardiac surgery. The surgeon passed a rubber tube in
the transverse sinus of pericardium. The blood vessel in front of the tube would be:
a) Superior vena cava.
b) Inferior vena cava.
c) Superior left pulmonary vein.
d) Pulmonary artery.
e) Abdominal aorta.
Answer  D.
The end-diastolic ventricular volume depends mainly upon:
a) Atrial contraction.
b) Distensability of the ventricle.

c) Duration of the diastole.

d) Respiratory movement.
e) Venous return.
Answer  E.
Coronary blood flow is regulated mainly by:
a) Autonomic nerve stimulation.
b) Arterial blood pressure.
c) Heart rate.
d) Hormones.
e) Myocardial oxygen consumption.
Answer  E
Emotional fainting (vasovagal syncope) is due to:
a) Anaphylactic shock.
b) Blood loss.
c) Loss of vasomotor tone.
d) Strong vagal stimulation.
e) Sympathetic stimulation.
Answer  D.
Current flow occurs in the heart to produce waves in the ECG when the heart is:
a) Completely polarized.
b) Completely depolarized.
c) Completely repolarized.
d) In the refractory period.
e) Partially depolarized and partially polarized.
Answer  E.
A patient with an electrolyte disturbance shows tall peaked T-wave and widened QRS complex in
the ECG. He is most likely to have raised plasma level of:
a) Calcium.
b) Chloride.
c) Magnesium.
d) Potassium.
e) Sodium.
Answer  D.
For the arterial blood pressure regulation, the most rapidly acting mechanism is:
a) Baroreceptor reflex.
b) Capillary fluid shift.
c) Rennin angiotensin mechanism.
d) Stress relaxation.
e) Vasopressin
Answer  A
The a-c interval of jugular venous pulse corresponds to which of the interval in ECG:
a) RR.
b) QRS.
c) PR.
d) QT.
e) VAT.
Answer  C.
Neurogenic shock is due to:
a) Antigen-antibody reaction.
b) Blood loss.
c) Decreased pumping ability of the heart.
d) Loss of vasomotor tone.
e) Severe infection.
Answer  D
A middle aged man suffering from hypoxia has arterial PO2-50 mmHg. His red cell count is 6.5
million/ml. He is most likely having:
a) Carbon monoxide poisoning.
b) Cyanide poisoning.
c) Hypoxic hypoxia.
d) Polycythemia vera.
e) Stagnant hypoxia.
Answer  C
Duration and rate of inspiratory ramp signals generated from the dorsal respiratory neurons in the
medulla oblongata is controlled by impulses from:
a) Carotid baroreceptors.
b) Aortic baroreceptors.
c) Cerebral cortex.
d) Hypothalamus.
e) Pneumotaxic center.
Answer  E.
Chest X-ray or echocardiogram in moderately severe mitral stenosis will show:
a) Left atrial enlargement and prominence of
pulmonary artery.
b) Left atrial and left ventricular enlargement.
c) Right and left ventricular hypertrophy.
d) Left ventricular dilatation.
e) Dilated aortic root.
Answer  A
A patient with left ventricular hypertrophy with significantiy increased end diastolic volume with
increase systolic and decreased diastolic value 145/45 and increased aortic pressure. There was early
diastolic murmur which was due to:
a. Tricuspid insufficiency
b. Aortic Regurgitation
C. Mitral Stenosis
D.Aortic StenosisS
Answer:  B
Explanation ,Aortic insufficiency a percentage of theblood regurgitates back Increased end diastolic
volumeIncreased systolic blood presure + Decreased DiastolicPressure in the aortaincrease in Aortic
pulse pressure (Systolic Diastolic )Ventricular Hypertrophy ( to raisecompliance)Increased Ventricular
end-diastolic volumeSoft, high-pitched, early diastolic decrescendo Murmur (AUstin Flint Murmur) (
Guyton )
A 70 years old lady presented with Atrialfibrillation. whats the Drug of choice ?
a. Digoxin
b. Amiodarone
C. Metoprolol
d. Warfarin
Answer  C
Explaination 
If patient is hemodynamically unstable  Synchronised DC cardioversion is done start from 100 Joule
IF pateint is stable we do either rate or rhythm control
Indicatiom for rhythm control
➊first time presentation
➋young age
➌reversable cause
➍cardiac failure
How to Do rhythm control
➊if patient present in first 48 hour Do cardioversion either pharmacological by amoidarone or
flecainide (exclude structural heart disease ) or DC cardioversion
➋if pateint present after 48 hrs Do TEE if no LV clot do cardioversion if clot is there anticoagulate the
patient and do elective cardioversion after 4 weeks
For rate control we put patient on, betablocker ,calcium channel blocker or digoxin Note Ivabridine is
contraindicated in atrial fibrillation.
Atrial fibrillation in Old Age  Rate Control+ Anticogulation First Line Beta Blocker and CCBs.
If not controlled withcombination therapy then Amiadrone
A.Fib in Old Age + Heart Failure  Digoxin ( Blockers avoided in CHF )
A.Fib Cardioversion First Line  Class I C ( flecainide,
propafenone)> Class III Antiarrhythmic agents (Amiodarone, Ibutilide, Sotalol)
Then DC cardioversion (most effective but reserved for those who remain in A Fib ).