WBR0454
| Author | PageAuthor::Neeraja Danda M.B.B.S |
|---|---|
| Exam Type | ExamType::USMLE Step 2 CK |
| Main Category | MainCategory::Internal medicine |
| Sub Category | SubCategory::Cardiovascular |
| Prompt | [[Prompt::A 53 year old male presents to the emergency room with acute shortness of breath. His respiratory rate is 32/min. Neck examination is showed in the picture, and cardiac auscultation is significant for an S3. Pulmonary exam reveals bilateral rales. Electrocardiogram shows ventricular tachycardia.What is the best next step in management? Citation:: C. Michael Gibson www.wikidoc.com, 2 April 2012]] |
| Answer A | AnswerA::Repeat electrocardiogram |
| Answer A Explanation | AnswerAExp::'''Incorrect''' No need to repeat the electrocardiogram |
| Answer B | AnswerB::Echocardiogram |
| Answer B Explanation | AnswerBExp::'''Incorrect''' Echocardiogram is a must for all heart failure patients to know whether it is systolic or diastolic dysfunction and measure ejection fraction. |
| Answer C | AnswerC::Digoxin |
| Answer C Explanation | AnswerCExp::'''Incorrect''' Digoxin is not useful in the acute setting |
| Answer D | AnswerD::Rapid synchronized cardioversion |
| Answer D Explanation | AnswerDExp::When arrhythmia is the cause of heart failure, the best next step in management is rapid synchronized cardioversion |
| Answer E | AnswerE::Dobutamine |
| Answer E Explanation | AnswerEExp::'''Incorrect''' Dobutamine is used when the patient does not respond to preload reduction, it is not the best immediate step here |
| Right Answer | RightAnswer::D |
| Explanation | [[Explanation::When arrhythmia is the cause of heart failure, the best next step in management is rapid synchronized cardioversion. Successful cardioversion causes the atrium and ventricles to contract coordinated in normal rhythm such that cardiac output can be maintained.
Educational Objective: Rapid synchronized cardioversion is the management of choice when arrhythmias like atrial fibrillation or ventricular tachycardia are the cause of pulmonary edema. To maintain cardiac output, heart chambers should be in regular rhythm. References: References:: Page 82,83,84,85 Master the boards Step 2 CK second edition, page 55 Master the boards Step 3 2009 edition |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Heart failure, WBRKeyword::arrythmia, WBRKeyword::Ventricular tachycardia, WBRKeyword::Cardioversion |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |