Antiarrhythmic medications — MCQs

A 54-year-old man comes to the emergency department because of episodic palpitations for the past 12 hours. He has no chest pain. He has coronary artery disease and type 2 diabetes mellitus. His current medications include aspirin, insulin, and atorvastatin. His pulse is 155/min and blood pressure is 116/77 mm Hg. Physical examination shows no abnormalities. An ECG shows monomorphic ventricular tachycardia. An amiodarone bolus and infusion is given, and the ventricular tachycardia converts to normal sinus rhythm. He is discharged home with oral amiodarone. Which of the following is the most likely adverse effect associated with long-term use of this medication?

A 63-year-old man with a history of hypertension and atrial fibrillation is brought into the emergency room and found to have a ventricular tachyarrhythmia. Ibutilide is discontinued and the patient is switched to another drug that also prolongs the QT interval but is associated with a decreased risk of torsades de pointes. Which drug was most likely administered in this patient?

A 65-year-old man with hypertension and paroxysmal atrial fibrillation presents to his cardiologist for follow-up after recently starting metoprolol for rate control. His EKG shows an atrial rate of 260/min with ventricular rate of 50/min on an irregular baseline. An echocardiogram from his previous visit revealed no evidence of hypokinesis or hypertrophy with functionally intact valves. The patient does not drink alcohol and had no evidence of liver dysfunction in prior studies. What is the best medication for rhythm control in this patient?

A 62-year-old man is brought to the emergency department because of syncope. He reports sudden onset of palpitations followed by loss of consciousness while carrying his groceries to his car. He is unable to recall any further details and does not have any chest pain or dizziness. He has a history of hypertension, type 2 diabetes mellitus, gastroparesis, and osteoarthritis of the knees. Medications include lisinopril, metformin, and ondansetron as needed for nausea. He also takes methadone daily for chronic pain. Apart from an abrasion on his forehead, he appears well. His temperature is 37.2 °C (98.9 F), heart rate is 104/min and regular, and blood pressure is 135/70 mm Hg. While he is in the emergency department, he loses consciousness again. Telemetry shows polymorphic ventricular tachycardia with cyclic alteration of the QRS axis that spontaneously resolves after 30 seconds. Results of a complete blood count, serum electrolyte concentrations, and serum thyroid studies show no abnormalities. Cardiac enzymes are within normal limits. Which of the following is the most likely underlying cause of this patient's syncope?

A 21-year-old woman presents with palpitations and anxiety. She had a recent outpatient ECG that was suggestive of supraventricular tachycardia, but her previous physician failed to find any underlying disease. No other significant past medical history. Her vital signs include blood pressure 102/65 mm Hg, pulse 120/min, respiratory rate 17/min, and temperature 36.5℃ (97.7℉). Electrophysiological studies reveal an atrioventricular nodal reentrant tachycardia. The patient refuses an ablation procedure so it is decided to perform synchronized cardioversion with consequent ongoing management with verapamil. Which of the following ECG features should be monitored in this patient during treatment?

A 71-year-old man develops worsening chest pressure while shoveling snow in the morning. He tells his wife that he has a squeezing pain that is radiating to his jaw and left arm. His wife calls for an ambulance. On the way, he received chewable aspirin and 3 doses of sublingual nitroglycerin with little relief of pain. He has borderline diabetes and essential hypertension. He has smoked 15–20 cigarettes daily for the past 37 years. His blood pressure is 172/91 mm Hg, the heart rate is 111/min and the temperature is 36.7°C (98.0°F). On physical examination in the emergency department, he looks pale, very anxious and diaphoretic. His ECG is shown in the image. Troponin levels are elevated. Which of the following is the best next step in the management of this patient condition?

A 70-year-old man presents to the emergency department with severe substernal chest pain of one hour’s duration. The patient was taking a morning walk when the onset of pain led him to seek care. His past medical history includes coronary artery disease, hyperlipidemia, and hypertension. Medications include aspirin, losartan, and atorvastatin. An electrocardiogram reveals ST elevations in the inferior leads II, III, and avF as well as in leads V5 and V6. The ST elevations found in leads V5-V6 are most indicative of pathology in which of the following areas of the heart?

A 48-year-old man presents to his primary care physician with diarrhea and weight loss. He states he has had diarrhea for the past several months that has been worsening steadily. The patient recently went on a camping trip and drank unfiltered stream water. Otherwise, the patient endorses a warm and flushed feeling in his face that occurs sporadically. His temperature is 97.2°F (36.2°C), blood pressure is 137/68 mmHg, pulse is 110/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for a murmur heard best over the left lower sternal border and bilateral wheezing on pulmonary exam. Which of the following is the best initial step in management?

A 74-year-old woman comes to the physician for a follow-up examination. Eight months ago, she underwent an emergency cardiac catheterization with stenting for myocardial infarction. At the time of discharge, her heart configuration was normal, end-diastolic volume was 300 mL and ejection fraction was 51%. For the past 8 weeks she has noticed increasing shortness of breath while playing with her 2-year-old grandson. She feels otherwise well. She has arterial hypertension, coronary artery disease, and hypercholesterolemia. She admits to rarely taking her medication as she usually feels well and has no symptoms. Her temperature is 37.3°C (99.1°F), pulse is 93/min, and blood pressure is 142/93 mm Hg. Examination shows no abnormalities. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range. ECG shows broad, deep Q waves and T-wave inversion. Echocardiography shows left ventricular dilation and an end-diastolic volume of 370 mL; Ejection fraction is 40%. Which of the following is most likely to have prevented this patient's worsening of ventricular function?

A 22-year-old patient presents to the rural medicine clinic for a physical examination. She has a past medical history of major depressive disorder. The patient has a history of smoking 1 pack of cigarettes daily for 5 years. She states that she is not currently sexually active, but had sexual intercourse in the past. Her paternal grandfather died of a heart attack at the age of 60. She takes citalopram by mouth once every morning. The blood pressure is 110/70 mm Hg, the heart rate is 76/min, and the respiratory rate is 12/min. Her physical examination reveals a well-nourished, alert, and oriented female. While auscultating the heart, a 2/6 holosystolic murmur at the left upper sternal border is present. Which of the following would be the most appropriate next step for this patient?