Quiz on antiarrhythmic drugs

A 75-year-old female with persistent atrial fibrillation and a history of heart failure with reduced ejection fraction (HFrEF, LVEF 30%) is being considered for rate control. She has been recently discharged after a hospitalization for worsening heart failure. Which of the following antiarrhythmic agents is the most appropriate choice for rate control in this patient? *

A 62-year-old male with a history of heart failure with preserved ejection fraction (HFpEF) and persistent atrial fibrillation is being considered for rate control. He has a history of bronchospasm, but no active wheezing. He is already on a stable dose of lisinopril and furosemide. Which of the following agents would be most appropriate for rate control in this patient? *

A 60-year-old male with a history of Wolff-Parkinson-White (WPW) syndrome and atrial fibrillation presents with rapid ventricular response (RVR) and is hemodynamically unstable. He is hypotensive with a blood pressure of 80/50 mmHg. What is the most appropriate immediate intervention? *

A 68-year-old male with a history of hypertension and hyperlipidemia presents to the emergency department with palpitations and dizziness that started this morning. His heart rate is 170 bpm, regular, and his blood pressure is 110/70 mmHg. An ECG reveals narrow complex regular tachycardia. He is hemodynamically stable. Which of the following is the most appropriate initial management? *

A 70-year-old male with persistent atrial fibrillation and a history of mild renal impairment (eGFR 40 mL/min/1.73m²) is being considered for rhythm control. He has no significant structural heart disease. Which of the following antiarrhythmic agents would require dose adjustment or careful monitoring due to his renal function? *

A 72-year-old female with chronic kidney disease (CKD) stage 4 (eGFR 25 mL/min/1.73m²) and atrial fibrillation is started on amiodarone for rhythm control. She is also taking warfarin for anticoagulation. Which of the following is a significant drug interaction to monitor closely? *

A 68-year-old male with a history of ischemic cardiomyopathy (LVEF 30%) and recent successful ICD implantation for primary prevention presents with a new diagnosis of persistent atrial fibrillation. He is currently on carvedilol. The decision is made to pursue rhythm control. Which of the following antiarrhythmic agents is most appropriate to initiate for rhythm control in this patient, considering his LVEF and carvedilol therapy? *

A 55-year-old female with a history of WPW syndrome undergoes electrophysiology study (EPS) which reveals an accessory pathway that conducts rapidly during atrial fibrillation. She has no symptoms and a normal LVEF. The EPS team recommends ablation. If she were to develop symptomatic atrial fibrillation with rapid ventricular response, which of the following agents would be *contraindicated* for acute management? *

A 70-year-old female with chronic atrial fibrillation is on amiodarone therapy for rhythm control. She complains of fatigue, weight gain, and feeling cold. Her thyroid-stimulating hormone (TSH) level is elevated. Which of the following is a common long-term adverse effect of amiodarone that needs to be considered in this patient? *

A 55-year-old male with a history of ischemic cardiomyopathy (LVEF 35%) and a prior myocardial infarction presents with sustained monomorphic ventricular tachycardia (VT). He is currently hemodynamically stable. He has no contraindications to antiarrhythmic therapy. Which of the following agents is most likely to be effective and appropriate for long-term suppression of VT in this patient? *

A 42-year-old female with no significant past medical history is found to have paroxysmal supraventricular tachycardia (PSVT) requiring pharmacologic intervention. She is hemodynamically stable. She has a history of asthma and is currently taking a short-acting beta-agonist for occasional wheezing. Which of the following drugs should be used with caution or avoided in this patient? *

A 75-year-old female with a history of recent myocardial infarction and a left ventricular ejection fraction of 40% is experiencing symptomatic premature ventricular contractions (PVCs) that are causing her significant distress. She is already on a beta-blocker. Which of the following antiarrhythmic agents would be most appropriate to consider for suppression of her symptomatic PVCs? *

A 65-year-old male with paroxysmal atrial fibrillation is prescribed propafenone for rhythm control. He reports experiencing a metallic taste in his mouth and some dizziness. He has no known history of structural heart disease or significant renal or hepatic impairment. Which of the following is the most likely adverse effect of propafenone? *

A 58-year-old male with a history of coronary artery disease and prior myocardial infarction presents with new-onset atrial flutter with a 2:1 block. He is hemodynamically stable. His ejection fraction is 45%. He has no history of heart failure. Which of the following is the most appropriate initial pharmacologic agent to attempt to convert him to sinus rhythm? *

A 45-year-old male presents with a single episode of syncope. An ECG reveals a prolonged QT interval (550 ms) and T-wave abnormalities. He has no history of cardiac disease. Which of the following is the most likely diagnosis? *

A 50-year-old male with a history of hypertrophic cardiomyopathy (HCM) presents with symptomatic ventricular ectopy. He has not responded well to beta-blockers. Which of the following antiarrhythmic agents would be most appropriate to consider for rhythm control in this patient, given his underlying condition? *