Medical-Surgical Nursing

A 57-year-old man is admitted to the Cardiac Unit with palpitations, headache, and chest tightness.

On auscultation S3 gallop and murmur can be heard. Blood pressure 97/60 mmHg, Heart rate 170 /min, Respiratory rate 25 /min, Temperature 37.3 C. What is the ECG rhythm of the patient?

  1. A Atrial fibrillation
  2. B Ventricular tachycardia
  3. C Ventricular fibrillation
  4. D Supra-ventricular tachycardia الإجابة الصحيحة

الشرح

Core Concept: Supraventricular Tachycardia (SVT) is a rapid, regular arrhythmia originating above the ventricles. A heart rate of 170 bpm with palpitations, chest tightness, and an S3 gallop (indicating heart failure/volume overload) is highly suggestive of SVT.

Clinical Presentation:

  • Palpitations, dizziness, chest pain, shortness of breath, sudden onset/offset.

Diagnosis:

  • *First-line:* 12-lead ECG showing narrow QRS complexes (<0.12s), absent or buried P waves, and rate 150-250 bpm.
  • *Gold Standard:* Electrophysiology (EP) study.

Management:

  • *Acute:* Vagal maneuvers (Valsalva, carotid massage), followed by IV Adenosine if unstable/persistent. Synchronized cardioversion if hemodynamically unstable.
  • *Definitive:* Beta-blockers, calcium channel blockers, or catheter ablation for long-term prevention.

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