Arrhythmias USMLE Step 1 Practice Question
A 42-year-old man with prior myocardial infarction presents with asymptomatic ventricular bigeminy on Holter monitoring. Vital signs: BP 118/76 mmHg, HR 72 bpm, RR 16, temp 37°C, SpO2 98% on room air. Transthoracic echocardiography shows ejection fraction of 28%. He denies syncope or palpitations. Current medications include lisinopril, metoprolol, and atorvastatin. Which of the following is the most appropriate management?
Answer choices
- AAdd amiodarone for PVC suppression
- BStart procainamide for suppression of premature ventricular contractions
- CStart sotalol to improve ejection fraction
- DImplant a pacemaker immediately
- EContinue current medications; no antiarrhythmic therapy indicatedCorrect answer
- FCatheter ablation to eliminate the PVC focus and reduce risk of VT
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