Question 1

A child with a history of asthma is brought to the clinic with a rapid heart rate. A cardiac monitor shows a heart rate of 225 beats per minute. The provider notifies transport to take the child to the emergency department. What initial intervention may be attempted in the clinic?

A) Intravenous adenosine
B) Administration of a beta blocker
C) A loading dose of digoxin
D) A carotid massage

D

Accepted Answer

A carotid massage can be attempted as an initial intervention to help slow down the heart rate by stimulating the vagus nerve, which can help terminate certain types of supraventricular tachycardia.

Question 2

A patient reports sustained, irregular heart palpitations. What is the most likely cause of these symptoms?&#10;A) Anemia&#10;B) Atrial fibrillation&#10;C) Extrasystole&#10;D) Paroxysmal attacks

Accepted Answer

Sustained, irregular heart palpitations are a key symptom of atrial fibrillation, a type of arrhythmia where the atria contract rapidly and irregularly. Anemia may cause heart palpitations, but they would not typically be sustained or irregular. Extrasystole and paroxysmal attacks may cause palpitations but are less likely to be sustained and irregular.

Question 3

An adult patient reports frequent episodes of syncope and lightheadedness. The provider notes a heart rate of 70 beats per minutes. What action will the provider take next?&#10;A) Evaluation of the patient's orthostatic vital signs&#10;B) Monitoring the patient's heart rate while the patient is bearing down&#10;C) Prescribing an electrocardiogram (ECG) and exercise stress test (ETT)&#10;D) Reassuring the patient that the symptoms are non-cardiac in origin

Accepted Answer

The patient's reported symptoms of syncope and lightheadedness suggest possible orthostatic hypotension. Evaluation of the patient's orthostatic vital signs, including blood pressure and heart rate measurement in different positions, can help confirm this diagnosis and guide management. Monitoring the patient's heart rate while bearing down or prescribing an ECG and exercise stress test may be indicated if other cardiac symptoms or risk factors are present, but are not the next best step based on the presented information. Reassuring the patient before a proper evaluation is not appropriate.

Deck 100: Cardiac Arrhythmias