Q:

A 52-year-old man develops postoperative supraventricular tachycardia to a rate of 180/min. and hypotension. The following is/are true:

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A 52-year-old man develops postoperative supraventricular tachycardia to a rate of 180/min. and hypotension. The following is/are true: 


  1. Since a heart rate of 180/min should be tolerated at his age, the hypotension must have another cause
  2. A vagal maneuver that breaks the tachycardia suggests atrial flutter as the etiology
  3. Atrial overdrive pacing should be tried for paroxysmal atrial tachycardia (PAT)
  4. Verapamil IV should be used for rate control
  5. Cardioversion is preferred for patients on digoxin

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c. Atrial overdrive pacing should be tried for paroxysmal atrial tachycardia (PAT)

d. Verapamil IV should be used for rate control 

A tachyarrhythmia over 150 beats/min can produce hypotension and myocardial ischemia and demands urgent therapy. Vagal maneuvers may break PAT but are not usually effective for atrial flutter or fibrillation. Atrial overdrive pacing should be attempted for PAT or atrial flutter. Verapamil is the most effective approach to rate control for supraventricular arrhythmias, but cardioversion of patients on digoxin should be undertaken cautiously since they are prone to ventricular tachycardia.

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