How Would You Manage This Patient’s Palpitations & Dyspnea?

Welcome to the next episode of The Reveal, where we take you inside the mind of a test taker to deconstruct and connect the dots of a board-style question so you can become a better student, transform how you learn, and excel not only on high-stakes exams but also in your general medical knowledge. Let’s get started.

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A 52-year-old man with a history of diabetes mellitus and hypertension presents to the ED with palpitations and dyspnea that have been present intermittently over the past week. His vital signs include HR 135 beats/minute, blood pressure 136/87 mm Hg, RR 15 breaths/minute, and oxygen saturation of 97% on room air. His electrocardiogram is shown above. Which of the following is the most appropriate initial management?

A) Administer intravenous adenosine

B) Administer intravenous diltiazem

C) Sedate the patient and perform synchronized cardioversion with 100 joules

D) Transport the patient to the cardiac catheterization suite

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