virgola82
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A 62 yo man was admitted to the hospital with anterior wall MI. Revascularization with a stent placed at the laef anterior descending artery was successful; perfusion was reportedly excellent. Bedside echocardiography performed at admission and after revascularization showed an EF of 55% with mild anterior wall motion abnormalities consistent with the infarction. Examination on day 2 showed a HR of 105/min, normal venous pressure, nomal heart sounds, and clear llung fields. No peripheral edema was present. A 12 lead EKG showed changes consistent with anterior wall MI. On telemetry, several ventricular premature contractions, both singly and in couplets givig a bigeminal pattern, were noted. What do you advise?
A. Electrophysiologic study and possible implantation of a cardioverter-defibrillator
B. Loading dose of amiodarone
C. increased dose of beta-blocker
D. No futher action
E. repeat Holter at dismissal
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| Justice
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(D)
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| arlete
Intern in 2009!!!!!
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C
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| prathapdoctor
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I think its C. We can further increase the beta blocker does considering his HR and EF.
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| MAGY17
Forum Elite
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D
this is reperfusion arrhythmia / accelerated idioventricular rhythm.
or not?
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| arlete
Intern in 2009!!!!!
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"several ventricular premature contractions, both singly and in couplets givig a bigeminal pattern" means there is sinus rhythm alternating with arrhythmia. Idioventricular accelarated rhythm is a monomorphic arrhythmia, a sequence of wide QRSs, all the time.
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| yasmeen
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D pvcs after mi requirres no management just observation
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| virgola82
Forum Guru
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The correct answer is C.
This patien has well-preserved left ventricular function. however his heart rate is not well controlled and would benefit from increased beta blockade
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