Common Arrhythmia in General Practice

This is the correct answer because atrial fibrillation is characterized by an irregularly irregular rhythm with the absence of P waves and a narrow QRS complex. The patient's sudden onset of palpitations and irregular pulse is typical. Research shows atrial fibrillation is common in the elderly with hypertension. Management includes rate control and anticoagulation to prevent thromboembolic events.

Atrial flutter typically presents with a 'sawtooth' pattern on ECG and more regular rhythm, not irregularly irregular.

Ventricular tachycardia usually presents with wide QRS complexes and may be associated with hemodynamic instability.

Sinus tachycardia would show a regular rhythm with visible P waves preceding each QRS complex.

Multifocal atrial tachycardia would show at least three different P wave morphologies and is more common in patients with lung disease.

Atrial fibrillation would show an absence of distinct P waves, not multiple morphologies.

Atrial flutter typically presents with a regular rhythm and characteristic 'sawtooth' pattern.

This is the correct answer as multifocal atrial tachycardia is characterized by at least three different P wave morphologies and irregular rhythm, commonly seen in patients with pulmonary diseases like COPD. The patient's history and symptoms align well with this diagnosis.

Sinus tachycardia is regular and would not show multiple P wave morphologies.

Ventricular tachycardia involves wide QRS complexes and is usually regular, not irregular.

Amiodarone is used for rhythm control but is not the immediate choice for unstable arrhythmias.

Beta-blockers can be used for rate control but are not suitable for acute management if there is hemodynamic instability.

Adenosine is not effective for atrial flutter as it works best on AV nodal reentrant tachycardia.

This is the correct answer because electrical cardioversion is indicated for hemodynamic instability or rapid ventricular rates in atrial flutter, especially in patients with compromised cardiac function. The patient's symptoms and ECG findings suggest an unstable rhythm that requires immediate intervention.

Calcium channel blockers can control rate but are not first-line in acute settings with instability.

Atrial fibrillation with rapid ventricular response typically presents with narrow complexes unless pre-existing bundle branch block is present.

This is the correct answer because ventricular tachycardia is characterized by wide QRS complexes and often leads to hemodynamic compromise, especially in patients with structural heart disease like coronary artery disease. The low blood pressure and wide-complex tachycardia strongly suggest VT.

Supraventricular tachycardia with aberrancy can mimic VT but is less likely in the setting of hemodynamic instability and coronary disease.

Atrial flutter typically presents with narrow complexes unless there is a pre-existing conduction defect.

Sinus tachycardia is usually narrow-complex and driven by physiological demand rather than an intrinsic arrhythmia.

This is the correct answer because adenosine is the first-line treatment for terminating acute episodes of paroxysmal supraventricular tachycardia (PSVT) by transiently blocking AV nodal conduction. The narrow complex and high rate suggest an AV nodal reentrant tachycardia, which is typically responsive to adenosine.

Beta-blockers can be used in some cases for rate control but are not the immediate choice for termination.

Calcium channel blockers may be used when adenosine is contraindicated or ineffective but are not first-line.

Electrical cardioversion is reserved for hemodynamic instability or refractory cases.

Digoxin is not effective for acute termination of PSVT and is more useful for chronic rate control.

Metoprolol is a beta-blocker that can be used but may need caution in patients with renal impairment.

Diltiazem is a non-dihydropyridine calcium channel blocker effective for rate control but can affect renal function.

This is the correct answer because digoxin provides effective rate control in atrial fibrillation, particularly in patients with heart failure and renal impairment. Its pharmacokinetics allow for safe use in this demographic, although monitoring is needed to avoid toxicity.

Amiodarone is more commonly used for rhythm control or when other agents are contraindicated.

Verapamil, similar to diltiazem, can be used for rate control but requires caution in renal impairment.

Atropine can be used in some cases of bradycardia but is often ineffective in complete heart block.

This is the correct answer because temporary transcutaneous pacing provides immediate support for symptomatic patients with complete heart block until more definitive treatment such as permanent pacing can be arranged. It prevents further episodes of syncope and stabilizes the patient's hemodynamics.

Permanent pacemaker implantation is the definitive treatment but requires more immediate stabilization with transcutaneous pacing.

IV fluids can support circulation but do not address the underlying bradycardia.

Observation is inappropriate given the risk of asystole and recurrent syncope.

Atrial fibrillation would not terminate with vagal maneuvers and is irregular.

Atrial flutter is regular but typically requires more than vagal maneuvers for termination.

This is the correct answer because AV nodal reentrant tachycardia (AVNRT) is characterized by a regular narrow-complex tachycardia that often terminates with vagal maneuvers like carotid sinus massage, which affects AV nodal conduction. It is the most common type of supraventricular tachycardia.

Ventricular tachycardia is usually a wide-complex tachycardia and does not respond to vagal maneuvers.

Atrioventricular reentrant tachycardia may also respond to vagal maneuvers but is less common than AVNRT.

Vitamin K can reverse warfarin but acts too slowly for acute bleeding scenarios.

FFP can be used for warfarin reversal but takes time to prepare and administer.

This is the correct answer because Prothrombin Complex Concentrate (PCC) provides rapid reversal of warfarin's effects and is indicated in life-threatening bleeding or significant risk of bleeding, as in this case of suspected intracranial hemorrhage.

Aspirin is contraindicated as it could worsen bleeding.

Increasing the warfarin dose would exacerbate the situation and is inappropriate.

Amiodarone can be used for stable ventricular tachycardia but is not the first choice in acute management.

Verapamil is contraindicated in wide-complex tachycardias due to risk of hypotension.

Adenosine is not effective for wide-complex tachycardias of ventricular origin.

This is the correct answer because synchronized cardioversion is indicated for hemodynamically unstable or symptomatic wide-complex tachycardias. It provides immediate rhythm conversion and symptom relief.

Magnesium is primarily used in torsades de pointes, not in regular wide-complex tachycardia.