Rate Control and Anticoagulation in Persistent Atrial Fibrillation with Asthma

Patient F-187, a 70-year-old woman weighing 70 kg, presents with a 12-hour history of palpitations and increasing breathlessness. She has a background of asthma and uses a salbutamol inhaler as required. She has no known allergies. She is not on any regular medication. She is not pregnant. On examination, she is comfortable at rest, heart rate is 130 bpm and irregularly irregular, blood pressure 135/80 mmHg, respiratory rate 18/min, oxygen saturation 96% on air. No signs of heart failure: no JVP elevation, no lung crepitations, no peripheral oedema. ECG shows atrial fibrillation with a rapid ventricular response, QRS narrow and no ischaemic changes. Blood tests: serum creatinine 0.9 mg/dL, eGFR 70 mL/min/1.73m², liver function tests normal. She has no hepatic impairment. The CHA2DS2-VASc score is 2 (age 1 point, female sex 1 point). Prescribe appropriate rate control therapy and anticoagulation.