A lady presents with grade 3 dyspnea. She has severe mitral strenosis with atrial fibrillation. Also increased ventricular rate with a clot in the left atrium. Which of the following should not be done?

Cardioversion with percutaneous balloon valvotomy Treatment of Mitral Stenosis Penicillin prophylaxis of group A beta-hemolytic streptococcal infections for secondary prevention of rheumatic fever is impoant for at-risk patients with rheumatic MS. Recommendations for infective endocarditis prophylazis have recently been changed. In symptomatic patients, some improvement usually occurs with restriction of sodium intake and small does or oral diuretics. Beta blockers, Nondihydropyridine calcium channel blockers (e.g., verapamil or diltiazem), and digitals glycosides are useful in slowing the ventricular rate of patients with AF. Wafarin to an international normalized ratio (INR) or 2-3 should be administered indefinitely to patients with MS, who have AF or a history of thromboembolism. The routine use of warfarin in patients in sinus rhythm with LA enlargement (maximal dimension >5.5 cm) with or without spontaneous echo contras is more controversial. If AF is of relatively recent onset in a patient whose MS is not severe enough to warrant PMBV (percutaneous mitral balloon valvotomy) or surgical commisurotomy, reversion to sinus rhythm pharmacologically or by means of electrical countershock is indicated. Usually, cardioversion should be undeaken after the patient has had at least 3 consective weeks of anticoagulant treatment to a therapeutic INR.