Wed3November0844PM 8

A 45-year-old man walks in to the Emergency department complaining of palpitations after going for a run. He denies chest pain, shortness of breath or dizziness.

His blood pressure is 138/60 mmHg, however the heart rate is 198/min regular. He has been investigated by his GP for intermittent palpitations, mostly noted on exercise. His recent 24 tape has been normal.

You attach him to an ECG monitor and the following ECG trace is noted:

Which of the following would be the most appropriate line of management?

(Please select 1 option)

Implantable cardioverter defibrillator (ICD)

Beta blocker This is the correct answer

Digoxin

Catheter ablation for arrhythmogenic focus

Defibrillation Incorrect answer selected

Explanation

The treatment decision for exercise-induced VT depends on the symptoms. If the symptoms are severe, such as presyncope or syncope, then catheter ablation of the focus is the treatment of choice. If symptoms are mild pharmacological therapy may be sufficient. This type of arrhythmia may spontaneously revert after an episode of exercise. However, if it does not it may degenerate into ventricular fibrillation and cause sudden cardiac death.

Pharmacologic therapy improves symptoms in a significant proportion of patients. The initial choice for therapy is usually a beta blocker. Catheter ablation or implantation of an ICD are also options. If a patient is only mildly symptomatic (as in this case), a trial of medications would be warranted.

Digoxin increases intracellular calcium and so can potentially trigger arrhythmogenic activity. Procainamide may prolong the QT interval.

Answer Statistics

1

30%

2

20%

3

1%

4

15%

5

36%

Times answered: 290