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Atropine therapy
0%
0/6
Carvedilol therapy
Diltiazem therapy
Ablative therapy
100%
6/6
Nitroglycerine therapy
Select Answer to see Preferred Response
This patient is presenting with signs and symptoms of supraventricular tachycardia (SVT), his EKG demonstrates a delta wave, suggestive of Wolff-Parkinson-White (WPW) syndrome. Definitive management for symptomatic patients with WPW is through radiofrequency ablation of the aberrant conduction pathway. WPW is a condition characterized by aberrant pre-excitation of the cardiac ventricular myocytes due to conduction of atrial depolarization through a tract other than the AV node, most typically through the Bundle of Kent. The refractory period of the AV node, then results in a re-entrant tachycardia resulting in SVT. Patients with symptomatic WPW are at risk of developing lethal arrhythmias, and thus should be treated through ablation of the aberrant conduction tract. Medical therapy with calcium channel blockers, beta blockers, or other medications that slow the AV node are contraindicated, as they increase the conduction through the accessory pathway. Figure/Illustration A shows an EKG with a shortened PR interval, and early upsloping R wave known as a delta wave (black arrows), highly suggestive of an accessory pathway such as in WPW. Incorrect Answers: Answer 1: Atropine is an appropriate first therapy for bradyarrhythmias, not tachyarrhythmias. Answer 2 and 3: Beta blockers and calcium channel blockers are not recommended for patients with WPW, as they can exacerbate degeneration into re-entrant tachycardias. Answer 5: Nitroglycerine is a vasodilatory medication used for the treatment of angina.
4.8
(6)
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