Supraventricular tachycardia — MCCQE Part 1 MCQ

Correct answer: E — Attempt vagal manoeuvres then give adenosine if unsuccessful

Attempt vagal manoeuvres then give adenosine if unsuccessful is best because stable regular narrow-complex tachycardia is treated initially with vagal manoeuvres/adenosine. Discharge after a single normal initial test is suboptimal because early cardiac disease can be missed by one isolated result; Arrange routine cardiology review without acute risk stratification is suboptimal because routine referral is too slow for a potentially unstable presentation; Give reassurance because the patient is young or previously well is suboptimal because age alone does not exclude serious cardiovascular disease; Treat only the symptom and omit ECG or biomarker-based assessment is suboptimal because cardiac presentations require objective assessment when suggested clinically. Instability would change the answer to synchronised cardioversion.

Reference: CCS arrhythmia guidance