A 47-Year-Old Man Is Brought to the Emergency Department Due

question 162

Multiple Choice

A 47-year-old man is brought to the emergency department due to lightheadedness and palpitations.  He denies chest pain, shortness of breath, or nausea.  He reports a history of palpitations since he was a teenager and says he can usually stop them by bearing down.  However, this maneuver did not work this time so he decided to come to the hospital.  His other medical problems include type 1 diabetes mellitus and hypertension.  He had a myocardial infarction 5 years ago, but has not had chest pain since then.  His exercise tolerance is good.
Blood pressure is 80/40 mm Hg and his pulse is 150/min.  Lungs are clear on auscultation.  No heart murmurs are appreciated.
ECG is shown in the exhibit.
Which of the following is the best next step in managing this patient?

• A)Bedside transthoracic echocardiogram
• B)Carotid sinus massage
• C)Intravenous adenosine
• D)Intravenous amiodarone
• E)Intravenous sedation and cardioversion

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