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Supraventricular tachycardia — MCCQE Part 1 MCQ

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ModeratePalpitationsSupraventricular tachycardiaMCCQE Part 1

A 29-year-old woman presents with sudden regular palpitations. ECG shows a narrow-complex regular tachycardia at 180/min, blood pressure is 118/74 mmHg and she is alert without chest pain or heart failure. Which of the following is the most appropriate next step?

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Correct answer: E — Attempt vagal manoeuvres followed by adenosine if unsuccessful

Stable regular narrow-complex tachycardia is usually AVNRT or AVRT and should be treated initially with vagal manoeuvres, then adenosine if needed. Cardioversion is reserved for instability or refractory cases, and chronic amiodarone is inappropriate as initial management. Holter monitoring alone misses the opportunity to terminate the acute symptomatic episode.

Reference: Canadian emergency medicine arrhythmia practice; CCS arrhythmia resources