Answer to the question on 12.04.2015:
Answer : A
The ECG is showing atrial fibrillation with fast ventricular rate. The important issue in this ECG is that the ventricular rate is extremely fast, reaching up to 300 bpm. AF with very fast ventricular rate is suggestive of conduction over bypass tracts. Patients with preexcited atrial fibrillation who are hemodynamically stable are to be treated with intravenous procainamide or ibutilide. Patients who present with hemodynamic instability should undergo urgent direct current cardioversion. So the right answer is intravenous procainamide. after management of the acute episode the patient should be advised to undergo electrophysiological study with ablation of the accessory pathway as definitive therapy.
Ref: Blomstrom-Lundqvist C, Scheinman MM, Aliot EM, et al: ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias—executive summary: A report of the American College of Cardiology/American Heart Association task force on practice guidelines and the European Society of Cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with
supraventricular arrhythmias). Circulation 108:1871–1909, 2003.
What is the site of origin of the premature ventricular contractions :
A. Right ventricular outflow tract
B. Left ventricular outflow tract
C. Papillary muscle
D. Left ventricular basal epicardium
I will put the explanation and answer tomorrow
Keywords: Cardiology review, Cardiology, Multiple choice questions, medical students, Electrophysiology