sobia naeem
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35 yr old femalewith history of chest tightness and palpitations for 2 hours.over the past 11 months she has had 5 similar episodes.she was given i/v medicine that caused conversion to sinus rhythm.her BP is 95/60,pulse is 165/min and regular.her lungs are clear on auscultation.what does she have?
a.accelerated idioventricular rhythm
b.accelerated junctional rhythm
c.atrial fib
d.multifocal atrial tachycardia
e.PSVT
F.Premature SV beats
g.PVC
h.sick sinus
i.sinus bradycardia
j.sinus tachycardia
k.ventricular fib
l.ventricular tachycardia
plz explain too.
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| mani
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e.PSVT??
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| chemamr
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?
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| stepkiller
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ithink it is AF atrial fibrillation. conversion done by injecting quinidine.
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| kingsofke
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If she still has 165 bpm rate after conversion the reasonable awnser is just what stepkiller said.
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| frontal
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It's TOUGH. Intravenous adenosine should terminate PSVT, but the pulse is still high. Shouldn't treated and terminated AF show a normal pulse rate, and if the attack is not terminated, shouldn't the pulse be irregularly irregular?
What does PVC stand for?
I hope the i.v. medicine mentioned was given in this episode. The question isn't very clear about this.
At present the patient is in sinus rhythm, with a rate of >100/min, which defines sinus tachycardia (or does it?) In any case, they're not after the post-treatment status.
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| sobia naeem
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the q did not mention the i/v medicine.the q was in nbme as posted.no ecg to help either.PVC stands for premature ventricular contractions.
by what i understand is that when u give quinidine there is improvement in the AV conduction and thus the irregular pulse due to A FIB gets corrected as the impulse is now flowing down to the ventricle creating sinus rhythm.but the pulse is still fast .so she is having sinus tachycardia right now.i think the q wanted us to know what she was having during all these episodes and that surely is A FIB.correct me if i am wrong!
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| an
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i think the answer is PSVT..this arrhythmia is known to come in paroxysms..and adenosine(or whatevr the iv medication that was used) just corrects the acute episode..it doesnt prevent recurrences...
the reason why i dont think it is atrial fib is that the qu says that right now she is having an episode( so unlikely to be sinus tachy) and pulse is 165 and regular, whereas AF is irregularly irregular pulse. plus she is symptomatic(chest tightness, low BP)
anyways, i took NBME 2 yday, and i put PSVT as answer..maybe i was wrong.
Edited by an on 02/21/06 - 06:25 AM
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| mani
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its cant be AF as his pulse is regular
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| stepkiller
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frontal is working up his whole cortex well. it shud be a PSVT.
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| robin082006
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I go with PSVT too
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| cooldudemle
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i go with PSVT . Kaplan says... PSVT refers to the ectopic tachyarrythmias that are charecterised by sudden onset and abrupt termination.... it is manifested as an absolutely regular rythm at arate between 130 and 220 beats/min. so it seems to meet the criteria..
IV adenosine and verapamil are effective in 90% of the patients of reentry involving av node.
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