A physician-validated, board-style question from the Active Transport QBank. Try it, then check the reasoning for every option.
A 45-year-old man with a history of hypertension and coronary artery disease presents to the emergency department after experiencing a syncopal episode while mowing the lawn. He reports feeling palpitations and lightheadedness prior to the event. His current medications include lisinopril and aspirin. ECG shows a wide complex tachycardia at a rate of 180/min. Which of the following is the most likely complication of this condition if left untreated?
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A
Aortic dissection with hemodynamic instabilityIncorrect. Aortic dissection is not a complication of VT; it has distinct etiology and presentation.
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B
Ventricular fibrillation leading to cardiac arrestCorrect. VT in ischemic heart disease commonly degenerates into ventricular fibrillation, causing sudden cardiac arrest.
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C
Atrial fibrillation with rapid ventricular responseIncorrect. AF presents as irregularly irregular, narrow-complex (usually); VT does not typically degenerate into AF.
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D
Heart block causing bradycardia and syncopeIncorrect. Heart block causes bradycardia; this patient has tachycardia at 180 bpm.
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E
Pulmonary embolism resulting in hypoxiaIncorrect. PE causes hypoxia and dyspnea but is unrelated to wide-complex VT as a sequela.
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Answer: B. The patient presents with a wide complex tachycardia, likely ventricular tachycardia (VT) given his coronary artery disease history. VT can degenerate into ventricular fibrillation, which is a life-threatening arrhythmia causing cardiac arrest. Atrial fibrillation typically presents with an irregular rhythm, and pulmonary embolism or aortic dissection would present with different clinical features. Heart block would result in bradycardia, not tachycardia.