Wed3November0844PM 1

A 76-year-old man is brought to the Emergency department.He has a history of left ventricular dysfunction secondary to ischaemic heart disease.

That morning he had developed sudden onset rapid, irregular palpitations, and felt breathless so he called the emergency services. On arrival at the Emergency department he was connected to a monitor, venous access was gained and a 12 lead ECG was recorded.

On examination he looked unwell; he was sweaty and his venous pressure was elevated. His pulse was 195 irregularly irregular. Heart sounds were normal. Auscultation of his lungs revealed crackles to mid-zones bilaterally. Blood pressure was recorded at 75/42 mmHg.

The 12 lead ECG showed a fast, irregular narrow complex tachycardia with absent P waves.

From this list, which is the treatment of choice for this patient?

(Please select 1 option)

Adenosine

Amiodarone intravenously

Direct current cardioversion (DCCV) Correct

Digoxin intravenously

Atenolol intravenously

Explanation

The management of tachyarrhythmias is dependent on the presence of adverse features. These include:

Myocardial ischaemia

Shock

Syncope, and

Heart failure.

When adverse features are present, synchronised DCCV under GA or conscious sedation is the treatment of choice.

This patient has a tachyarrhythmia (probable atrial fibrillation [AF]) with signs of heart failure therefore the most appropriate management is DCCV.

If adverse features are not present, it is appropriate to try drugs first.

For AF (complicated by heart failure) digoxin or amiodarone are indicated.

Therefore the correct answer is Direct current cardioversion (DCCV).

Answer Statistics

1

2%

2

3%

3

96%

4

1%

Times answered: 274