Author: Paul Watson / Editor: Jason M Kendall / Reviewer: Nadarajah Prasanna, Phil Delbridge / Codes: CC3, CP3, HP2, ResP1, SLO1, SLO2, SLO6 / Published: 16/11/2023
A 48-year-old gentleman presents at 3am to the emergency department (ED) having woken at 2am with palpitations. He has known intermittent arrhythmias, with 6 episodes over the last 2 years. His last attendance was 1 month ago. He underwent electrophysiology at that time, and has been booked for ablation therapy in 3 days time. In preparation for this, his usual bisoprolol was stopped 4 days ago, as he must be free of any anti-arrhythmics for one week prior to the procedure.
On previous occasions attempts at cardioversion with adenosine have been unsuccessful; treatment with verapamil and electrical cardioversion have both been successful.
He has mild chest pain (3/10 severity), and is warm and sweaty. He had no dyspnoea or nausea.
He has no other previous medical history, and apart from his bisoprolol, has no other medications. He is a non-smoker.
His heart rate is 180 with a BP of 127/85.
He is keen to stress that he does not want any attempt at chemical cardioversion, as he does not want to jeopardise his forthcoming ablation therapy.
A nurse presents you with the following ECG:
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Question 1 of 3
1. Question
In your risk assessment of this patient following the history, examination and ECG, which one of the following is most appropriate?
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Question 2 of 3
2. Question
In order to effectively manage this patient's tachycardia, you need to assess the cardiac rhythm. Which of the following options are true? (Select all that apply)
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Question 3 of 3
3. Question
You decide to attempt chemical cardioversion with adenosine. Unfortunately, this is unsuccessful and you progress to electrical cardioversion. Which of the following options are true? (Select all that apply)
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14 responses
very useful case
Good case
Clear, and useful.
very informative
Good case
My query is if patient had 6 unsuccessful attempt with adenosine in past, was it necessary to give another 3 doses with no effect this time.He needed electrical cardioversion anyway.
Good case
Good learning points
Thank you. Very helpful.
thanks
Good case
good
good recap
Great one