arrhythmias/ventricular tachycardia

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Question 1 / 3

683c98b6bf0c2b5ee08e4a75

Cardiology

arrhythmias

ventricular tachycardia

Case History

A 58-year-old male, with a history of long-standing hypertension, dyslipidemia, and a 30-pack-year history of tobacco use, presents to an urgent care clinic reporting intermittent chest discomfort over the past few days, now accompanied by a new onset of rapid heartbeats. He describes the sensation as a "racing heart" that started abruptly about an hour ago. He denies syncope, lightheadedness, or significant dyspnea. His blood pressure is 128/84 mm Hg, heart rate 155 beats/minute, respiratory rate 16 breaths/minute, and oxygen saturation 98% on room air. On physical examination, he appears anxious but is alert and oriented, his skin is warm and dry, and peripheral pulses are palpable and regular. Cardiac auscultation reveals a rapid, regular rhythm with no murmurs. Lung fields are clear to auscultation. A 12-lead electrocardiogram obtained upon arrival reveals a wide QRS complex tachycardia (QRS duration > 0.14 seconds) at 150 bpm, with monomorphic morphology and evidence of AV dissociation. Considering the patient's current presentation and ECG findings, what is the most likely underlying arrhythmia and the immediate appropriate management strategy?

Lab Parameter	Value	Reference Range
Hemoglobin	145 g/L	130-170 g/L
White Blood Cell Count	7.8 x 10^9/L	4.0-11.0 x 10^9/L
Sodium	139 mmol/L	135-145 mmol/L
Potassium	4.2 mmol/L	3.5-5.0 mmol/L
Magnesium	0.90 mmol/L	0.70-1.10 mmol/L
Troponin I	<0.02 µg/L	<0.04 µg/L

A ) Supraventricular Tachycardia with aberrancy and intravenous adenosine administration.

B ) Monomorphic Ventricular Tachycardia and immediate synchronized electrical cardioversion.

C ) Monomorphic Ventricular Tachycardia and intravenous amiodarone administration.

D ) Polymorphic Ventricular Tachycardia and immediate unsynchronized defibrillation.

E ) Atrial Fibrillation with rapid ventricular response and intravenous procainamide administration.

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Question 2 / 3

683c98b6bf0c2b5ee08e4a76

Cardiology

arrhythmias

ventricular tachycardia

Case History

A 62-year-old female presents to an outpatient clinic for a routine follow-up when she suddenly experiences retrosternal burning and lightheadedness, rapidly progressing to near-syncope. Her medical history includes a myocardial infarction eight years prior and well-controlled hypertension. On assessment, she appears acutely distressed, pale, and diaphoretic. Her vital signs are: blood pressure 85/50 mmHg, heart rate 160 beats/minute, respiratory rate 22 breaths/minute, SpO2 94% on room air. Her ECG is shown, displaying a wide-complex tachycardia. Considering her clinical presentation and ECG findings, what is the most likely diagnosis and the immediate definitive management strategy?

Lab Parameter	Value	Reference Range
Hemoglobin	135 g/L	120-150 g/L
Sodium	140 mmol/L	135-145 mmol/L
Potassium	3.2 mmol/L	3.5-5.0 mmol/L
Magnesium	0.8 mmol/L	0.7-1.1 mmol/L
Troponin I	0.05 µg/L	<0.04 µg/L
Creatinine	75 µmol/L	45-90 µmol/L

A ) Premature atrial contractions with aberrant conduction and observation

B ) Atrial flutter with rapid ventricular response and intravenous diltiazem

C ) Paroxysmal supraventricular tachycardia with aberrancy and intravenous adenosine

D ) Ventricular tachycardia and immediate synchronized cardioversion

E ) Sinus tachycardia with underlying hypovolemia and rapid intravenous fluid bolus

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Question 3 / 3

683c98b6bf0c2b5ee08e4a77

Cardiology

arrhythmias

ventricular tachycardia

Case History

A 62-year-old female presents to the urgent care clinic complaining of sudden onset of lightheadedness and palpitations for the past 30 minutes. She reports a brief episode of near-syncope just before arriving. Her past medical history includes hypertension and type 2 diabetes, well-controlled. On examination, she is alert but appears anxious. Her blood pressure is 85/55 mmHg, heart rate is 185 beats/min, respiratory rate is 22 breaths/min, and oxygen saturation is 96% on room air. She has a palpable, rapid, and regular pulse. A rapid bedside ECG shows a regular wide-complex tachycardia. Given her presentation, what is the most likely rhythm and the immediate priority for her management?

Lab Parameter	Value	Reference Range
Hemoglobin	13.5 g/dL	12.0-16.0 g/dL
Potassium	3.2 mmol/L	3.5-5.0 mmol/L
Troponin I	<0.01 ng/mL	<0.04 ng/mL
Creatinine	75 µmol/L	45-90 µmol/L

A ) Supraventricular Tachycardia with aberrancy and administer intravenous adenosine.

B ) Polymorphic Ventricular Tachycardia and administer intravenous procainamide.

C ) Monomorphic Ventricular Tachycardia and proceed with immediate synchronized cardioversion.

D ) Ventricular Tachycardia and administer intravenous amiodarone.

E ) Torsades de Pointes and administer intravenous magnesium sulfate.

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