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Wide-complex tachycardia — ABEM Board MCQ

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HardCardiovascular emergenciesWide-complex tachycardiaABEM Board

A 69-year-old man with prior myocardial infarction arrives with palpitations and lightheadedness. Triage acuity is ESI 2; BP 106/68 mm Hg, HR 176/min, SpO2 96%. ECG shows a regular monomorphic wide-complex tachycardia. He is alert and has no pulmonary edema. Which of the following is the most appropriate initial action?

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

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Correct answer: B — Treat as ventricular tachycardia with IV procainamide or amiodarone

In an older patient with structural heart disease, regular wide-complex tachycardia should be treated as ventricular tachycardia unless proven otherwise.

Reference: AHA ACLS 2025 tachycardia algorithm