Case-Based Modules > Case 22

The information we have so far is: 1) he came in with a cardioembolic event, and now we have the etiology, 2) he's in a-fib (ECG shows an irregular irregular rhythm without discernible P waves), 3) now with rapid ventricular response (RVR) based on his HR > 100, and 4) he's mentating well. Cardioversion could very well be necessary, but we don't actually know if it's needed at this second. We'd need to be careful as there'd be a risk of throwing more emboli as his left atrium regains its kick with cardioversion. However, if he's unstable, then we'd have to proceed with cardioversion per ACLS guidelines, as the risk there would far outweigh this aforementioned embolic risk. The normal mentation implies adequate cerebral perfusion, which is somewhat reassuring. Unclear if he has chest pain due to his aphasia, but at least he's not clutching his chest. What we really need to know is whether or not he's hemodynamically stable. What can we do to find out?

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