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Chapter 9. Arrhythmia

In which of the following patients with atrial fibrillation (AF) would dofetilide be indicated?

a. A patient initiated in an outpatient setting.

b. A patient on intermittent hemodialysis.

c. A patient with a baseline QTc 510 milliseconds.

d. A patient with left ventricular hypertrophy (LVH)

Answer d is correct. Dofetilide is safer in patients with structural heart disease and ventricular hypertrophy.

Answer a is incorrect. Dofetilide must be initiated in an inpatient setting under telemetry.

Answer b is incorrect. Dofetilide is contraindicated in patients with a creatinine clearance (CrCl) <20 mL/min.

Answer c is incorrect. Dofetilide is contraindicated in patients with a QTc >440 milliseconds (or 500 milliseconds with a ventricular conduction abnormality).

RT is a 65-year-old woman who presents with paroxysmal supraventricular tachycardia (PSVT), heart rate (HR) 180 bpm, with a regular rhythm. RT is experiencing mild symptoms and was instructed to bear down as if having a bowel movement with no success. If RT has a narrow QRS interval, what medication(s) is(are) first-line agent(s) to treat this patient? Select all that apply.

a. Adenosine

b. Verapamil

c. Procainamide

d. Amiodarone

Answer a is correct. Adenosine is indicated for the treatment of patients with PSVT with a narrow QRS interval and a regular rhythm.

Answer b is correct. Verapamil is indicated for the treatment of patients with PSVT with a narrow QRS interval and a regular rhythm.

Answer c is incorrect. Procainamide is used for the treatment of patients with PSVT and an irregular rhythm.

Answer d is incorrect. Amiodarone is used for patients with PSVT with a wide QRS interval.

A 68-year-old woman weighing 60 kg presents to the emergency room in AF and is hemodynamically unstable. It is decided to proceed with direct current cardioversion (DCC). Which of the following would be appropriate anticoagulation therapy to administer prior to DCC? Select all that apply.

a. Enoxaparin 60 mg

b. Unfractionated heparin (UFH) 4800 unit bolus followed by 1100 units/h by continuous infusion

c. Enoxaparin 40 mg

d. Enoxaparin 30 mg

Answer a is correct. The appropriate dose of enoxaparin prior to DCC is the full treatment dose of 1 ...

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