Aashi
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A 35-year-old Asian man comes to the emergency department after a syncopal episode that occurred one hour ago while exercising. The patient spontaneously recovered five minutes later. He remembers having palpitations, shortness of breath, and dizziness prior to fainting. He recalls having occasional palpitations and dizziness for years. The patient has no significant medical history. On examination, his heart rate is 140/min, and his respiratory rate is 22/min. He is afebrile. The cardiac examination reveals a normal S1 and S2 with no audible murmurs or gallops. His respiratory and abdominal examinations are benign. There is no evidence of peripheral edema. Three sets of troponins, six hours apart, are within normal limits, and the chest x-ray reveals no cardiopulmonary disease. A cardiac electrophysiologic study was performed and produced sustained ventricular tachycardia. The EKG shows marked ST elevation in right precordial leads with an incomplete right bundle branch block. What is the best treatment for this patient?
(A) Flecainide
(B) Beta-blocker, nitroglycerin, aspirin, and oxygen
(C) Verapamil
(D) Amiodarone
(E) Pacemaker placement
(F) Implant cardioverter/defibrillator device
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| robin082006
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ventricular tachycardia+an incomplete right bundle branch block---> I go with F
This case is dangerous of sudden death due to ventricular fibrilation
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| Aashi
Forum Moderator
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Excellent Robin
This patient has Brugada syndrome, which is characterized by marked ST-segment elevation in the right precordial leads (V1-V3) with an incomplete right bundle-branch block pattern. It is associated with a high incidence of sudden death resulting from ventricular fibrillation ...
Because the risk of VF is high in patients without prior VF episodes, implantation of an implantable cardioverter/defibrillator (ICD) has been advocated as a primary therapy
GL
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"Obstacles are those frightful things you see when you take your EYES off your goal."
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| liwei
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ICD for sure
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