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Answer 2
  1. Thyroid function studies and TTE. A TTE would provide information about the patient’s left ventricular systolic function (which would help decide whether to anticoagulate) and atrial size (which may help predict the likelihood of remaining in sinus rhythm following cardioversion). Thyroid function studies are also appropriate because a hyperthyroid state may cause an intermittent rapid heart rate and explain this patient’s palpitations. Cardiac biomarkers are not indicated in the absence of ischemic symptoms or ECG changes. A TEE would only be indicated if immediate cardioversion was planned.1

     Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) [published erratum appears in J Am Coll Cardiol 2007;50:562]. J Am Coll Cardiol 2006;48:854-906.

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