q3 cardiac arrhythmia - zkadhem

[ArchivalUser]

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

[ArchivalUser]

CCC.

Event recorder is a good choice for her.

[ArchivalUser]

Hi stepcs123, You have sensible options, but think again

[ArchivalUser]

b??

[ArchivalUser]

hmmm. DDDDD

She has SVT, she should be given Beta-blocker. She cannot document the rhythm by heself. CC is not a ans. But I read the same question in a book, they says a event recorder is a good choice. so confused here!!

[ArchivalUser]

bb

[ArchivalUser]

stepcs123, I'm totally confused about the whole cardiology, so let's try to build some good explanations from here and there.
I will post the answer in a while just to give other friends the chance to answer.

thx

[ArchivalUser]

Answer: E. This patient has a classic history for paroxysmal supraventricular tachycardia (PSVT), not panic attacks. She can be cured with catheter ablation, whether or not the diagnosis is AV node re-entrant tachycardia (AVNRT) or an accessory pathway mediated tachycardia. A Holter monitor is unlikely to catch an episode because the Holter captures only 24 hours. An event recorder is more likely to provide a noninvasive diagnosis but will only confirm what is clear from the patient™s history and will delay therapy. Medication may suppress the arrhythmia but is undesirable if the patient wishes to become pregnant.

[ArchivalUser]

thx, eee is correct.

[ArchivalUser]

most welcome.