Atrial Fibrillation
(Rate Control)
Atrial Fibrillation
(Rate Control)
Patient with Atrial Fibrillation (new or longstanding OK) who would benefit from monitoring and rate control
Normal Mental Status
HR < 150 BPM.
If over 75 years old HR < 130
Otherwise Stable Vital Signs
Baseline functional status
Hypotension
Decreased mental status
Significant lab abnormalities
Evidence of end organ damage
Cardiac monitoring
ECG and/or Labs including TSH/T4, CBC, BMP, Mag
AV Nodal Blockers
Metoprolol
Metoprolol 25 mg PO BID (or higher if already on this)
Metoprolol 5-10 mg IV push Q15 minutes for HR > 100
Diltiazem
Diltiazem 30 MG Q6h
Diltiazem 0.25 mg/kg as bolus followed by 10 mg IV Push Q 15 minutes for HR > 100
Consider discussion with cardiology for patient with no contraindication to cardioversion
Anticoagulation
Per Pharmacy
Disposition
HR Controlled or Sinus Achieved
Outpatient PO regimen including rate control and anticoagulation
Follow up with Cardiology or PCP.
Unstable vital signs or worsening clinical condition
Significant lab or imaging abnormalities
Patient unable to take PO medications or able to safely care for self in home environment.
Patient unable to ambulate
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