skip to main content

Exercise Restriction in Pericarditis — EECC MCQ

Instant feedback + full explanation. One question, done properly.

HardPericardial DiseaseExercise Restriction in PericarditisEECC

A teenager with catecholaminergic polymorphic ventricular tachycardia continues to develop bidirectional VT on exercise despite a maximally tolerated non-selective beta-blocker. What is the next pharmacological step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Add flecainide to continued nadolol with repeat exercise-provocation testing

Flecainide is added to a maximally tolerated non-selective beta-blocker when exercise-provoked ventricular arrhythmia persists, with repeat exercise or catecholamine provocation used to assess suppression. Verapamil monotherapy abandons preferred beta-blockade; adding sotalol to nadolol is not the evidence-based adjunct and adds QT and renal-dose risk; adding amiodarone adds substantial extracardiac toxicity without equivalent CPVT evidence; and increasing nadolol above the tolerated dose is unsafe. Digoxin does not suppress CPVT ectopy and may increase arrhythmic risk.

Reference: 2022 ESC Guidelines for ventricular arrhythmias and sudden cardiac death. https://academic.oup.com/eurheartj/article/43/40/3997/6675633