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Ventricular Tachycardia — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyVentricular TachycardiaEECC

A 62-year-old man with a history of anterior MI and LVEF 35% presents with a broad-complex tachycardia at 170 bpm. The QRS width is 160 ms with RBBB morphology. He is alert with blood pressure 95/60 mmHg and some breathlessness. The rhythm does not respond to adenosine. What is the most appropriate next step?

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

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Correct answer: B — Intravenous amiodarone 300 mg over 20-60 minutes

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as D · D = shown as E

This broad-complex tachycardia in a patient with structural heart disease should be treated as VT. He is haemodynamically compromised but not peri-arrest. IV amiodarone is recommended for haemodynamically tolerated VT in structural heart disease. Flecainide (B) is contraindicated in structural heart disease. DC cardioversion (C) if unstable/deteriorating. Lidocaine (D) is second-line. Verapamil (E) is absolutely contraindicated in broad-complex tachycardia.

Reference: ESC (2022): Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death