Dysrhythmia

Chapter 26 Dysrhythmia




Clinical Case Problem 1 A 37-Year-Old Man with “Skipping Heart Beats”


A 37-year-old man comes to your office for assessment of “skipping heartbeats.” These skipped beats have been a concern for the past 8   months. The patient reports no other symptoms accompanying these skipped beats. Specifically, he reports no increased sweating, no palpitations, no weight loss, no chest pain, no pleuritic pain, and no anxiety.


On physical examination, his blood pressure is 100/70   mm Hg. On auscultation of his heart, you observe that S1 and S2 are normal—there are no extra sounds or murmurs. You hear approximately five premature beats per minute.



Select the best answer to the following questions




1. What is the most commonly encountered “premature contraction”?


a. a ventricular premature beat

b. an atrial premature beat

c. atrial flutter

d. atrial fibrillation

e. none of the above

2. Most atrial premature beats discovered on clinical examination are


a. associated with chronic obstructive pulmonary disease (COPD)

b. completely benign

c. associated with valvular heart disease

d. associated with an increase in cardiovascular mortality

e. none of the above

3. Most ventricular premature beats discovered on clinical examination are


a. associated with COPD

b. completely benign

c. associated with valvular heart disease

d. associated with an increase in cardiovascular mortality

e. none of the above


Clinical Case Problem 2 A 51-Year-Old Man with Acute Chest Pain


A 51-year-old man presents to the emergency department with an acute episode of chest pain. He has a history of atrial fibrillation. On examination, his blood pressure is 80/60   mm Hg and his ventricular rate is approximately 160 beats/minute. He is in acute distress. His respiratory rate is 32 breaths/minute. His electrocardiogram (ECG) shows atrial fibrillation with a rapid ventricular response.



4. What should your first step in management be?


a. digitalize the patient

b. give the patient intravenous (IV) verapamil

c. give the patient IV adenosine

d. start synchronized cardioversion

e. start rapid IV hydration


Clinical Case Problem 3 A 44-Year-Old White Man with Palpitations


A 44-year-old white man comes to the emergency department saying he has palpitations. He denies chest pain or shortness of breath. There is no history of known heart disease or cardiac risk factors except for mild obesity. He does admit to drinking heavily the night before at an office retirement party.


On physical examination, his blood pressure is 120/80   mm Hg and his ventricular rate is 160 beats/minute. His ECG confirms atrial fibrillation with a rapid ventricular response.



5. What should you do at this time?


a. digitalize the patient

b. treat the patient with IV verapamil

c. treat the patient with IV procainamide

d. cardiovert the patient

e. have him perform a Valsalva maneuver by rebreathing into a paper bag

6. What is the recommended treatment of paroxysmal supraventricular tachycardia (PSVT) with hemodynamic compromise?


a. synchronized cardioversion

b. direct-current countershock

c. IV adenosine

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Dysrhythmia

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