Supraventricular Arrhythmias MCQs

Sinus bradycardia and pauses up to 3 seconds are common in young individuals, particularly in highly trained athletes. (You know Mr. Kohli) Given the normal ECG, lack of symptoms, and normal physical examination, no further testing is warranted. Reference: Basic & Clinical Pharmacology, Fourteenth Edition By Bertram G. Katzung Pg no. 245

Toxic multinodular goitre usually occurs in women over 55 years of age and is more common than Grave's disease in the elderly. Her atrial fibrillation may well be related to this. Her goitre is obstructing, with significant retrosternal extension, and surgery is the treatment of choice. Initially, however, she should be rendered euthyroid with antithyroid drugs such as carbimazole. Reference: Harrison's Principles of Internal Medicine 21 st edition Page:2948

In a patient with liver disease, it is important to exclude hypoglycemia as a cause of unconsciousness. Following confirming that baseline observations and BM is normal, the next best step is to perform a CT of his head to exclude a central neurological cause of decreased conscious level. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 28, Pg: 187

Digitalis is one of a number of drugs that may be associated with gynaecomastia. Causes of gynaecomastia; Drugs: (DISCCO) D igoxin I soniazid S pironolactone C imetidine C yproterone O estrogen Other causes: Thyrotoxicosis Liver disease Estrogen-producing tumors HCG-producing tumors Starvation/refeeding Carcinoma of the breast Reference : Harrison's Principles of Internal Medicine 21 st edition Page 3018

This patient has microcytic anaemia and is also on warfarin. So the priority is to rule out bleeding. Since upper GI endoscopy and colonoscopy were normal, the next step would be capsule endoscopy which helps to see bleeds in small bowel . In this case angiodysplasia of small bowel could be a cause of bleeding. In capsule endoscopy, a patient swallows a small pill which emits a radio frequency which is picked up by a sensor that the patient wears over several hours. Images are then downloaded as a continuous movie. Another possible cause of GI bleed in a patient with AF is mesenteric insufficiency, which will be characterized by abdominal pain post prandial. In that case mesenteric angiography will be the investigation. Reference : Harrison's Principles of Internal Medicine, 21 st ed, Ch: 322, Pg:2417

Amiodarone is most effective for maintenance of sinus rhythm. Beta-blockers and non-dihydropyridine calcium channel blockers are used to control ventricular rate in patients with Atrial fibrillation. Reference: Harrison's Principles of Internal Medicine 21 st edition Page 1907

A patient with atrial fibrillation and hemodynamic instability (hypotension/shock/impaired consciousness/heart failure/angina) is treated with DC cardioversion. In a patient with AF without hemodynamic instability, the two approaches to management include controlling the heart rate or restoring sinus rhythm. Flecainide is the drug most likely to restore sinus rhythm in atrial fibrillation. Other drugs include Amiodarone, sotalol, dronaderone, propafenone etc. Adenosine is used in patients with supraventricular tachycardia (SVT). Digoxin and Bisoprolol are indicated for rate control and are not normally associated with the restoration of sinus rhythm. Verapamil can be used for rate control in atrial fibrillation, and may be used in the treatment of SVT. Reference: Harrison's Principles of Internal Medicine 21 st edition Page 1907

As there is > 70% carotid artery stenosis and symptoms suggestive of emboli, endarterectomy is recommended. The patient should also be anticoagulated afterwards in view of atrial fibrillation. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 427, Pg: 3347