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Cardiology

Answer 5
  1. IV adenosine. IV adenosine is the most appropriate choice for a patient with stable supraventricular tachycardia (SVT). Given the ST depressions on ECG, which suggest ischemia, an IV ß-blocker would be a reasonable alternative. Electrical cardioversion is a consideration for rapid termination of SVT in a patient who exhibits hemodynamic instability but must be synchronized to prevent ventricular fibrillation (VF). Amiodarone is not a first-line treatment for SVT. IV heparin or glycoprotein IIb/IIIa inhibitors are reasonable considerations for patients in whom cardiac ischemia from acute coronary syndrome is suspected. At this time, it is more likely that this patient’s cardiac ischemia is caused by supply demand mismatch from the rapid heart rate.2,3

    REFERENCES
    2.
     Blomström-Lundqvist C, Scheinman MM, Aliot EM, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias). J Am Coll Cardiol 2003;42:1493-531.

    3. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/ Non-ST-Elevation Myocardial Infarction). J Am Coll Cardiol 2007;50:e1-157.

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