dr confused
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A 65-year-old obese man is transferred to the telemetry unit because he experienced an episode of atrial fibrillation with a rapid ventricular response while undergoing dialysis. The nurse calls you to the bedside because she was alerted that he had an episode of ventricular tachycardia for about 10 seconds. The telemetry reading shows multiple episodes of premature ventricular complexes over the last 24 hours. His past medical history is significant for diabetes mellitus, hypertension, and chronic renal failure. He feels well. His physical examination reveals a pulse of 93/min, a blood pressure of 110/83 mm Hg, and a normal respiratory rate. There are chronic venous changes and pitting edema on the lower extremities with a glove and stocking-like distribution of sensory deficit. Laboratory studies show: potassium 3.9 mEq/L, BUN 30 mg/dL, creatinine 3.6 mg/dL, and glucose 30 mg/dL. Echocardiography performed a month ago shows an ejection fraction of 54% and normal left ventricular function. What is the best management for this patient?
(A) Temporary transcutaneous pacing
(B) Mapping with ablation therapy
(C) Implantable cardiac defibrillator (ICD) placement
(D) Electrophysiologic studies are required as soon as possible
(E) No further intervention
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| Kamsi
Forum Guru
Topics: 103
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B
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| dr confused
Forum Senior
Topics: 66
Posts: 107
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try again
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| guangyu
Forum Elite
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D
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| spmvj
Forum Newbie
Topics: 3
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C
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| arlete
Intern in 2009!!!!!
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D
But I would give him glucose right now!!!!!
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| dr confused
Forum Senior
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Answer:
(E) No further intervention
Explanation:
Long-term studies have shown that patients with premature ventricular contractions (PVCs) or nonsustained ventricular tachycardia without structural heart disease have a benign, long-term prognosis and do not require special intervention. This patient has no symptoms, no history of coronary disease, and a normally functioning heart as shown on echocardiogram. Those patients with ischemic heart disease have an increased risk of sudden death when in the presence of this type of arrhythmia. Another factor that greatly influences prognosis is a poor left ventricular function (ejection faction of <40%), in which case electrophysiological studies and, perhaps, an ICD placement is indicated. When the patient is otherwise healthy, asymptomatic, and has a normal ventricle on echocardiogram, do not offer treatment for nonsustained VT or PVCs.
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| arlete
Intern in 2009!!!!!
Topics: 30
Posts: 2,208
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Good question.
I don't think the patient is healthy, though, and the fact that he has a normal echo does not necessary mean he has a structurally normal heart, since he's got hypertension, he may have already microscopic alterations of myocardium.
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When men make the rules, God decides the exceptions.
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| RitaM
Forum Newbie
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To sort between C and D it is difficult.The VT was for 10 seconds so I was wondering whether it is significant or not.I would go with electrophysiological study.
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