Hypertrophic cardiomyopathy Quiz: Ace Your Exams

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A 15-year-old girl presents to the emergency department following a witnessed syncopal episode while running a half-marathon. The patient collapsed suddenly at mile 11 and was unconscious for approximately one minute. Upon arrival, the patient looks uncomfortable and is experiencing difficulty breathing. Temperature is 37.5 °C (99.5 °F), pulse is 126/min, respirations are 32/min, blood pressure is 107/65 mm Hg, and oxygen saturation is 94% on room air. On physical exam, a loud systolic ejection murmur is heard at the lower left sternal border. Lungs are clear to auscultation bilaterally. Intravenous access is established, supplemental oxygen is administered, and the patient is attached to the cardiac monitor. Telemetry shows the following non-sustained finding which spontaneously converts back to normal sinus rhythm. Which of the following is the best next step in management?

^{Reproduced from: Wikipedia}

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Perform cardiac bedside ultrasonography

Administer nitroglycerin

Administer adenosine

Place implantable cardiac defibrillator (ICD)

Apply defibrillation pads