#march2020mccqe1
A 21-year-old man is brought by his roommate to the emergency department because of abrupt onset of shortness of breath, mild chest pain, and a sensation of rapid heart beating. The patient says that in the past he had similar episodes, which resolved with the Valsalva maneuver or breath holding. This time, these measures were unsuccessful. He does not take any medication and is otherwise in good health. An ECG documents supraventricular tachycardia with a pulse of 200/min. Under ECG monitoring, gentle massage over the right carotid sinus is attempted, but the attack does not cease. Which of the following is the most appropriate next step in treatment?
(A) Further carotid sinus massage
(B) IV lidocaine
(C) IV procainamide
(D) IV verapamil
(E) Oral verapamil
A 21-year-old man is brought by his roommate to the emergency department because of abrupt onset of shortness of breath, mild chest pain, and a sensation of rapid heart beating. The patient says that in the past he had similar episodes, which resolved with the Valsalva maneuver or breath holding. This time, these measures were unsuccessful. He does not take any medication and is otherwise in good health. An ECG documents supraventricular tachycardia with a pulse of 200/min. Under ECG monitoring, gentle massage over the right carotid sinus is attempted, but the attack does not cease. Which of the following is the most appropriate next step in treatment?
(A) Further carotid sinus massage
(B) IV lidocaine
(C) IV procainamide
(D) IV verapamil
(E) Oral verapamil
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