Case No. 96

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Case No. 96

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Chief Complaint:

"I feel fluttering in my chest"

Published: Aug. 30, 2017
Case No. 96
Author: Jason2475
CASE SCENARIO

You are evaluating a 55-year-old female who presents for chest discomfort. The patient states "I feel fluttering in my chest now for 2 hours." She has mild chest discomfort but is denying pressure-like pain and pleuritic chest pain. She has associated shortness of breath and mild lightheadedness. The patient has a history of hypertension, hypothyroidism, and GERD. She denies recent changes to her thyroid medications and had normal thyroid function tests 1 week ago at her primary doctors office. The patient is tachycardic to the 160s and blood pressure is 137/82. EKG shows that the patient is in a supraventricular tachycardia (SVT). You try vagal maneuvers, adenosine 6mg, and adenosine 12mg but the patient remains in SVT. The patient now appears lethargic and diaphoretic. Repeat blood pressure is 74/48.

QUESTION

What is the next best step in management?

transcutaneous cardiac pacing
transvenous cardiac pacing
synchronized cardioversion
defibrillation