Answer and Explanation 14

14.  The correct answer is B.  The patients heart rate is high and needs to have better rate control.  The patient needs to be anti-coagulated.  Digoxin may be helpful for rate control or the patient had a poor ejection fraction.  This would be tough to manage acutely as an outpatient.  The patient does not need a stress test at this point.  Having the patient valsalva may help with the patients rate but if they do not convert they still need to be anti-coagulated.