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A 64-Year-Old Man Is Admitted to the Hospital with Palpitations

question 383

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A 64-year-old man is admitted to the hospital with palpitations and lightheadedness for the past several days. He has experienced palpitations previously, but recently they have seemed sustained and "uncomfortable." The patient has had no chest pain or shortness of breath. He has a history of coronary artery disease and prior percutaneous coronary interventions. He is treated with metoprolol, lisinopril, aspirin, clopidogrel, and rosuvastatin. Echocardiogram shows mild left ventricular dilation, a left ventricular ejection fraction of 30%, and no major valvular abnormality. Serum potassium is 4.2 mEq/L and magnesium is 1.9 mg/dL. On day 2 of hospitalization, the patient develops sudden-onset palpitations that feel like "fluttering in my chest." Blood pressure is 122/60 mm Hg. He is alert and does not appear to be in distress. Examination shows clear lungs bilaterally. His ECG strip is shown below. $A 64-year-old man is admitted to the hospital with palpitations and lightheadedness for the past several days. He has experienced palpitations previously, but recently they have seemed sustained and uncomfortable. The patient has had no chest pain or shortness of breath. He has a history of coronary artery disease and prior percutaneous coronary interventions. He is treated with metoprolol, lisinopril, aspirin, clopidogrel, and rosuvastatin. Echocardiogram shows mild left ventricular dilation, a left ventricular ejection fraction of 30%, and no major valvular abnormality. Serum potassium is 4.2 mEq/L and magnesium is 1.9 mg/dL. On day 2 of hospitalization, the patient develops sudden-onset palpitations that feel like fluttering in my chest. Blood pressure is 122/60 mm Hg. He is alert and does not appear to be in distress. Examination shows clear lungs bilaterally. His ECG strip is shown below. Which of the following is the best next step in management of this patient? A) Amiodarone B) Carotid sinus massage C) Digoxin D) Electrical cardioversion E) Esmolol$ Which of the following is the best next step in management of this patient?

Definitions:

Dream Dictionary

A reference book that lists common dreams and interprets their meanings.

Primary Process Thinking

In psychoanalytic theory, the term for the strange and primitive style of unconscious thinking manifested by the id.

Psychoanalytic Therapy

A therapeutic approach that seeks to explore unconscious conflicts and desires, based on Freudian psychology.

Unconscious Conflicts

Refers to internal struggles, often stemming from repressed thoughts or experiences, that influence behavior and mental states without the individual's awareness.