Mon25October0844PM 13

A 57-year-old man presents with palpitations which are fast and regular. The ECG strip confirms supra- ventricular tachycardia (SVT). He has a past medical history of asthma.

You decide to treat him with intravenous verapamil. He reverts to sinus rhythm after a 5 mg dose. Three hours later you called to the ward to reassess the same man.

Whilst examining him, you notice a bruise on his forehead. He mentions that he got up to go to the toilet whilst on the ward and woke up on the floor. This is all he remembers of the event. At this point he is back in SVT at a rate of 150 beats per minute, has a normal blood pressure, and has no chest pain, shortness of breath or dizziness.

Which of the following is the most appropriate way of managing this patient?

(Please select 1 option)

Amiodarone infusion

Bisoprolol intravenously

Second dose of verapamil IV Incorrect answer selected

DC cardioversion This is the correct answer

Adenosine to diagnose underlying rhythm

Explanation

Though this patient is haemodynamically stable when reassessed, he mentions a recent history of syncope, indicating that circulation has been compromised due to the fast heart rate. A second dose of verapamil would not be ideal in this situation.

Given the history of asthma, both adenosine and beta blockers are contraindicated.

Amiodarone is not a drug of choice for managing SVT.

Treatment with elective DC cardioversion would be recommended.

Answer Statistics

1

25%

2

3%

3

22%

4

26%

5

26%

Times answered: 273