Case Presentation: 74 year old female with past medical history of end stage renal disease on hemodialysis, hypothyroidism and atrial fibrillation on anticoagulation therapy with Apixaban presented to emergency department (ED) after an episode of near-syncope following her dialysis session. In the ED she was hypotensive and tachycardic. Electrocardiogram findings showed Atrial fibrillation(AF) with rapid [...]