Tachyarrhythmia management

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  • Tachyarrhythmia management
A 62 year old man visits his GP. He suffers from palpitation (feeling of rapid heart beat), head pressure, dizziness and shortness of breath. He also feels weak and incapable. Patient describes that there is "one engine working". His medical history is significant for hypertension, diabetes, MI and ischemic heart disease with decreased ejection fraction of left ventricle under 40%. What are you going to do with him next?

You call an ambulance, let him lie and cannulate venous access.

Correct answer

YES, the malignant fibrillation and sudden cardiac arrest can occur, calling an Ambulance is definitely the correct answer.


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You call an his son to bring him home, let him lie till he arrives. You recommend a cardiological examination.

Wrong answer

NO, patient is neither clear nor stable. There is a possibility of malignant fibrillation. This condition can lead to cardiac arrest or death.


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You call an his son to bring him to hospital, let him lie till he arrives. You recommend a cardiological examination.

Wrong answer

NO, the malignant fibrillation and sudden cardiac arrest can occur. If you call an ambulance when cardiac arrest occurs, there will be an undesirable and dangerous delay.


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You ask him some appropriate questions to make sure he is fine and send him to neurological examination.

Wrong answer

NO, he is not able to get to the hospital on his own. Most likely he can suffer from an arrhythmogenic syncope and this condition can lead to cardiac arrest or death.


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GP ... general practicioner, EF ... ejection fraction, MI ... myocardial infarction×
 
RR

15 bpm

HR

not available

SpO2

95 %

BP

110/60 mmHg

ECG

not available

Examination:
Medical history: diabetes mellitus type II- oral antidiabetics and diet, hypertension, stp. myocardial infarction in age of 56, with residual hypokynesis of heart documented by transthoracic echocardiography;

Medication: Siofor 500mg 1-0-1, Anopyrin 100mg 1-0-0, Sortis 40mg 0-0-1, Betaloc ZOK 50mg 1-0-0, Tritace 2,5mg 1-0-0

Gly

not available

ABG

not available

CBC

not available

biochemistry

not available