DrVirgo
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A 70-year-old man comes to the emergency department
complaining of chest palpitations and light-headedness.
These symptoms have occurred intermittently for
years but now seem to be occurring almost daily. The
symptoms usually come and go in a matter of minutes.
This morning, however, the symptoms did not resolve,
prompting the patient to seek medical care. He has a
blood pressure of 132/88 mm Hg, pulse of 170/min,
respirations of 22/min, and a temperature of 37 C (98.6
F). Examination is remarkable for runs of a normal
rhythm interspersed with a regular tachycardia. A
review of the patient’s rhythm strip reveals an alternating
normal sinus rhythm and a narrow complex tachycardia.
Before the patient’s runs of tachycardia, an atrial
premature beat can be seen. Immediately following
the Q wave is a small upward deflection on the rhythm
strip, which the physician refers to as “a pseudo-R
wave.” On the basis of this information, the patient
receives a carotid massage and is instructed on how to
perform a Valsalva maneuver. Despite these interventions,
his tachycardia continues.Which of the following
is the next appropriate intervention to treat this
patient’s tachycardia?
(A) Adenosine
(B) Amiodarone
(C) Amlodipine
(D) DC cardioversion
(E) Digoxin
what is the diagnosis and whats the answer?
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| robin082006
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B
VT?
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| Aashi
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AVNRT---->SVT--->t/t-->FIRST vagal manuevers-->fails--> give adenosine/ betablockers/CCB-------->A ,here
and if he was hemodynamically unstable--->DC cardiversion
GL
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| robin082006
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yes this is AVNRT, answer is A, new thing to remember, thanks both of you.
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| mjl1717
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Well this is what I asked before -when do you use Adenosine or Amniodarone? Because under exam circmstances seeing all those A's could be a big time problem.
Found out that Adenosine is used for the AV nodal "REENTRY" tachycardia./ but could initiate A fib.
Amiodarone if sometimes used in to treat A fib and is toxic.
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| robin082006
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this question is so tricky.
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| DrVirgo
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A.
This patient has a classic presentation
of atrioventricular nodal reentrant tachycardia
(AVNRT). Regardless of whether you recognize the
classic EKG findings (initiation by an atrial premature
beat; pseudo-R waves representing a buried, late
P-wave), you should recognize the treatment for a stable,
supraventricular tachycardia. The first intervention
should be a vagal maneuver, such as direct pressure on
the eyes, carotid massage, a Valsalva maneuver, or sudden
immersion in cold water (to name a few). If these
interventions fail, as they often do, a small bolus of
adenosine, which can be doubled and repeated, is the
next appropriate intervention. Adenosine will block the
AV node temporarily. If the rhythm is supraventricular,
the atrial rhythm will be easier to see. If the rhythm is
nodal in origin, it can be suppressed, allowing for the
native rhythm to take over.
Amiodarone (choice B) does have nodal blocking properties
but is usually not necessary for AVNRT, which
can be chronically suppressed with selective nodal
blocking agents that have a safer side-effect profile.
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| elitoki
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A  Adenosine
AVNRT has heart rate between 150 to 250.
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| arlete
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Robin:
VT has wide complexes.
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| liliaeliz
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