Diagnosis of Tachycardia
The patient, a young college student, presents with an uneasy chest sensation and a rapid, regular heart rate of $172$ beats per minute.
Effect of Vagal Maneuver
Carotid sinus pressure, a common vagal maneuver, was applied. This intervention successfully reduced the heart rate to a normal level of $72$ beats per minute.
Evaluating Diagnostic Options
- Ventricular tachycardia (VT): Less common in young, healthy individuals without underlying heart disease. While it can be regular, the dramatic response to vagal stimulation is less typical.
- Atrial fibrillation (AF): Characterized by an irregularly irregular pulse, which contradicts the stated regular heart rate of $172$ bpm.
- Sinus arrhythmia: A normal variation; a rate of $172$ bpm is pathologically high for sinus rhythm.
- Paroxysmal supraventricular tachycardia (PSVT): This condition involves sudden episodes of rapid heart rates originating above the ventricles. It commonly affects young people and is often characterized by a regular, fast rhythm. PSVT is frequently terminated by vagal maneuvers, as the increased vagal tone slows conduction through the AV node, interrupting the re-entrant circuit.
Conclusion
The patient's age, the sudden onset of a regular, rapid heart rate ($172$ bpm), and the termination of the tachycardia with carotid sinus pressure strongly suggest Paroxysmal supraventricular tachycardia (PSVT).
Important Questions from General Clinical Conditions
- The height of the Jugular Venous Pulse is determined by :
- The SA node is situated at the junction of:
- Reverse splitting of second heart sound is most commonly seen in :
- A 70-year-old man with dyspnoea on exertion has been found to have a single second heart sound and a loud diamond-shaped, rough quality systolic murmur best heard at the right $2^{nd}$ intercostal space, radiating to the right carotid artery. Which one of the following is the likely diagnosis ?
Consider the following statements with regard to pulmonary embolism :
1. Unexplained breathlessness is the most common symptom.
2. When congestive heart failure or pneumonia fail to improve despite standard medical treatment, occult pulmonary embolism should be considered.
3. Patients with high clinical likelihood of venous thromboembolism should first undergo D-dimer testing alone without obligatory imaging tests.
Which of the statements given above are correct?
