GP emergency management

A mature woman with palpitations

Gordian Fulde, Gonzalo Aguirrebarrena



Annie is 67 years old and is new to your practice. She presents today complaining of palpitations. She has been feeling very unwell over the past two days. She says that she only suffers from hypercholesterolaemia, which is controlled by diet.

Key Points

  • Atrial fibrillation is the most common cardiac arrhythmia and requires active treatment to prevent life-threatening complications. There is about a 5% annual incidence of stroke in patients with atrial fibrillation.
  • Patients with haemodynamic instability, heart failure and/or chest pain require urgent stabilisation, anticoagulation and rhythm control in an emergency department.
  • The choice of long-term antithrombotic or anticoagulation agent for prevention of stroke is based on the patient’s CHA2DS2-VASc score, taking into account relative and absolute contraindications in eachpatient.