DC Treatment Planning & Management 3 — Questions and Answers
Question 1: A patient with symptomatic high-degree AV block does not respond to atropine. What is the next best intervention?
- Adenosine 6 mg IV push
- Transcutaneous pacing (Correct answer)
- Amiodarone 300 mg IV
- Verapamil 5 mg IV
Correct answer: Transcutaneous pacing
Transcutaneous pacing is the next step when atropine fails to treat symptomatic high-degree AV block.
Question 2: A patient presents with WPW syndrome and atrial fibrillation with a rapid ventricular rate showing wide, irregular complexes. Which drug is contraindicated?
- Procainamide IV
- IV adenosine (Correct answer)
- Synchronized cardioversion
- Ibutilide IV
Correct answer: IV adenosine
Adenosine (and AV nodal blockers like beta-blockers, CCBs, digoxin) are contraindicated in pre-excited AF as they may accelerate conduction via the accessory pathway.
Question 3: For a patient with recurrent symptomatic paroxysmal supraventricular tachycardia refractory to medications, what is the long-term curative treatment of choice?
- Lifelong beta-blocker therapy
- Radiofrequency catheter ablation (Correct answer)
- Permanent pacemaker implantation
- ICD implantation
Correct answer: Radiofrequency catheter ablation
Radiofrequency catheter ablation offers a high cure rate for PSVT by eliminating the reentrant circuit.
Question 4: Which of the following is the correct initial vagal maneuver to attempt in a stable patient with narrow-complex SVT?
- Carotid sinus massage on both sides simultaneously
- Valsalva maneuver (Correct answer)
- Ice water facial immersion
- Ocular pressure
Correct answer: Valsalva maneuver
The Valsalva maneuver is a safe, effective first-line vagal maneuver for terminating SVT.
Question 5: A patient is found in pulseless electrical activity (PEA). After initiating CPR and securing IV access, which drug is administered?
- Amiodarone 300 mg IV
- Lidocaine 1 mg/kg IV
- Epinephrine 1 mg IV every 3–5 minutes (Correct answer)
- Atropine 1 mg IV
Correct answer: Epinephrine 1 mg IV every 3–5 minutes
Epinephrine 1 mg IV every 3–5 minutes is the primary pharmacologic agent in PEA arrest.
Question 6: A patient with sick sinus syndrome has symptomatic bradycardia with pauses up to 4 seconds. What is the definitive management?
- Chronic oral theophylline therapy
- Permanent pacemaker implantation (Correct answer)
- Long-term transdermal atropine patch
- Radiofrequency ablation of the SA node
Correct answer: Permanent pacemaker implantation
Symptomatic sick sinus syndrome with significant pauses is a Class I indication for permanent pacemaker implantation.
Question 7: When using amiodarone for rhythm control of atrial fibrillation, which serious long-term side effect requires regular monitoring?
- Renal toxicity
- Pulmonary toxicity (Correct answer)
- Hepatic arterial thrombosis
- Adrenal insufficiency
Correct answer: Pulmonary toxicity
Amiodarone can cause pulmonary toxicity (pneumonitis/fibrosis) requiring periodic chest X-ray and PFT monitoring.
DC Treatment Planning & Management 3
A patient with symptomatic high-degree AV block does not respond to atropine.
What is the next best intervention?