Question

A 23 year old male presents with syncope. He reports that while walking briskly to his car, he felt his heart ""racing"" in his chest, and shortly thereafter passed out. The patient denies any prior syncopal episodes, but does note occasional episodes of palpitations that occur after moderate activity or during periods of increased stress. There is no family history of neurological disease, cardiac disease, or sudden cardiac death. On physical examination, pulse is 85 and regular, BP is 124/74, respiratory rate is 16, and oxygen saturation is 98% on room air. Cardiac examination reveals pulsation at the fifth intercostal space at the left parasternal area in the midclavicular line. S1 is within normal limits, and S2 is heard to split on inspiration. The remainder of the physical exam is unremarkable. EKG taken in the office shows the following tracing in lead II. Which of the following would be the most

appropriate treatment for this patient's disorder?
A. Radiofrequency ablation of pre-excitation pathway
B. Urgent DC cardioversion
C. Heart transplant
D. Biventricular pacemaker placement
E. Coronary angioplasty

Answer 1

The patient appears to have an arrhythmic disorder and might benefit from radiofrequency ablation of the pre-excitation pathway to correct the abnormal electrical activity causing his palpitations and syncope. Urgent and invasive treatments such as heart transplant or DC cardioversion are unlikely to be the first-line treatments without evidence of more severe heart disease or failure.

Step-by-step explanation:

The clinical presentation described suggests that the 23-year-old male may have an arrhythmic disorder possibly triggered by exercise or stress, which led to his syncope. Considering his symptoms and the information given, the most appropriate treatment in his case would likely be a specific intervention to correct the abnormal electrical pathway that might be causing his palpitations and syncope. The management options provided include various procedures and devices, but without detailed EKG results to identify the type of arrhythmia, a definitive treatment recommendation is not possible. However, given that the patient's heart rate and rhythm are currently regular and he has no history of heart failure or structural heart disease, more urgent and invasive options such as a heart transplant or urgent DC cardioversion would not be first-line treatments.

An arrhythmia such as supraventricular tachycardia can often be managed with radiofrequency ablation of the pre-excitation pathway, especially if episodes are frequent or symptomatic. This option may be most applicable here, as it directly addresses potential aberrant electrical conduction that can cause tachycardia and related symptoms.

Final recommendations would be based on further diagnostic findings, such as a more detailed EKG, Holter monitoring, electrophysiological studies, or imaging studies if needed. This would allow for more precise identification of the arrhythmia type and focused treatment.