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 Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Heart failure, WBRKeyword::arrythmia, WBRKeyword::Ventricular tachycardia, WBRKeyword::Cardioversion
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::