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Torsades de pointes — SCE Acute Medicine MCQ

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EasyAcute Cardiac PresentationsTorsades de pointesSCE Acute Medicine

A 58-year-old man presents with acute chest symptoms with haemodynamic concern. Relevant history includes cardiovascular risk factors or structural heart disease. On assessment, haemodynamic findings and ECG changes are present. Investigations show polymorphic VT with QTc 560 ms and hypokalaemia. What is the most appropriate next step in management?

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Correct answer: C — Give intravenous magnesium and correct potassium while stopping QT-prolonging drugs

The key discriminator is that polymorphic VT with QTc 560 ms and hypokalaemia, which makes Give intravenous magnesium and correct potassium while stopping QT-prolonging drugs the single best answer. Give controlled oxygen and senior review is less appropriate because it does not address the dominant acute risk in the vignette; Arrange routine outpatient follow-up would fit a different presentation or later stage of care. Give intravenous fluids with reassessment and Give analgesia and antiemetic therapy are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: Resuscitation Council UK ALS; BNF