04-18-2009, 06:39 PM
Q.3. A 24-year-old woman has monthly episodes of a racing heart. The palpitations start abruptly, are regular at over 200 bpm, and typically end abruptly after 15 to 20 minutes. She can occasionally make the episode resolve with a Valsalva maneuver. She has never had an ECG during an episode, but has come to the emergency room on several occasions just afterwards, where the ECG always shows normal sinus rhythm at 70 to 90 bpm. She was recently married and would like to become pregnant but is concerned about the palpitations. What would be the appropriate management?
A. Educate the patient that she is having panic attacks and teach her to breathe into a paper bag when the episodes occur
B. Prescribe a Holter monitor to assess her rhythm over 24 hours
C. Prescribe an event recorder so she can document her rhythm with the next episode
D. Start her on a β-blocker with instructions to return if symptoms recur
E. Refer her for electrophysiology (EP) study and catheter ablation
A. Educate the patient that she is having panic attacks and teach her to breathe into a paper bag when the episodes occur
B. Prescribe a Holter monitor to assess her rhythm over 24 hours
C. Prescribe an event recorder so she can document her rhythm with the next episode
D. Start her on a β-blocker with instructions to return if symptoms recur
E. Refer her for electrophysiology (EP) study and catheter ablation