Case-Based Modules > Case 24 > Stage 2

This is very reasonable. This patient has a large MCA infarct with some petechial hemorrhaging, so we may not want to necessarily start therapeutic anticoagulation just yet. Electrical cardioversion can cause myocardial stunning; it's probably more likely to cause this than chemical cardioversion. So, while we'd want to initiate therapeutic anticoagulation after either DCCV or amiodarone, and can't in this case just yet, choosing the former may pose a theoretically higher risk of causing further thromboembolic events with delays in anticoagulation initiation.

It's also important to note, however, that choosing DCCV would've been another reasonable answer choice. It'd be the more classically textbook answer choice since the patient is hemodynamically unstable with a-fib. The nuances above make this answer choice of amiodarone reasonable.

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