Supraventricular tachycardia Quiz: Ace Your Exams

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A 67-year-old man presents to the emergency department for evaluation of the acute onset of palpitations and lightheadedness. The patient's partner states he has been under tremendous stress this past week. She reports he has had poor sleep, increased caffeine intake and heavy alcohol use throughout the week. He has a past medical history of atrial fibrillation status post ablation. The patient has a history of alcohol use disorder and smokes 1-2 cigarettes per day. He does not take any daily medication. Temperature is 37°C (98.6°F), pulse is 170/min, respirations are 20/min, blood pressure is 76/54 mmHg, and oxygen saturation is 94% on room air. The patient appears pale, diaphoretic and is incoherent. Cardiopulmonary exam reveals a regular brisk tachycardic pulse. Lead II of the patient’s electrocardiogram (ECG) is shown below. Which of the following is the best next step in management?

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Synchronized cardioversion

Defibrillation

Amiodarone

Magnesium sulfate

Adenosine