QuestionSBA
QuestionChoice
This is correct. The patient is presenting with regular narrow complex tachycardia with adverse features, i.e. signs and symptoms of myocardial ischaemia, she therefore urgently requires DC Cardioversion.
10035602
a
Arrange urgent DC Cardioversion
QuestionChoice
This is not appropriate as this is used in broad complex tachycardias. In addition, the patient has adverse features.
10035605
d
Administer 300mg amiodarone
QuestionChoice
This would be the correct second-line approach in the absence of adverse features.
10035604
c
Administer 6mg Adenosine
QuestionChoice
This would be the correct first-line approach to acute narrow complex tachycardias in the absence of adverse features.
10035603
b
Attempt vagal manoeuvres
QuestionChoice
The priority is proceeding down the advanced life support tachycardia algorithm, normalising the rate and then subsequently the patient will require a PCI.
10035606
e
Urgent PCI
QuestionComment
From LITFL:
New LBBB in the context of chest pain was once considered a “STEMI-equivalent” and part of the criteria for thrombolysis. However, more up-to-date data suggests that chest pain patients with new LBBB have little increased risk of acute myocardial infarction at the time of presentation.
53698
QuestionComment
Would be appropriate to have their troponin
60973
User
subscriber
Neutrophillia
User
subscriber
Serotonin Migraine
Concept
Chapter
2693
5886
Acute narrow complex tachycardias
Topic
134
Cardiology
19524
In patients with narrow complex tachycardia and signs of myocardial ischaemia, urgent direct current cardioversion is often necessary.
A 73-year-old woman is admitted to the hospital with palpitations and new onset chest pain. She is normotensive and tachycardic on examination. An ECG demonstrates a narrow complex tachycardia of 150 with a new left bundle branch block in the inferior leads. An initial troponin I is 1200.

What is the most appropriate initial course of action?
a