A 43-year-old male patient presents to the emergency department with a one-hour history of chest tightness, palpitations, and generalized weakness. He does not report shortness of breath, sweating, or dizziness. His past medical history is unremarkable, he is a non-smoker and denies alcohol or illicit drug use. His father experienced a myocardial infarction at 72 years old. Vital signs reveal a heart rate of 125 beats per minute, blood pressure of 120/76 mmHg, and he is afebrile. His mental status is unimpaired; he is alert and oriented to person, place, and time. His electrocardiogram reveals atrial fibrillation. What investigation should be prioritized in this patient’s initial evaluation?

A 65-year-old male patient with a medical history of hypertension controlled with amlodipine, is transported from his home to the emergency department (ED) via Emergency Medical Services (EMS) due to experiencing shortness of breath and new onset palpitations. Upon arrival, his vital signs are as follows: blood pressure is 95/62 mm Hg, heart rate is at 165 beats/min, respiratory rate at 26 breaths/min, and a reported temperature of 38.9°C. The 12-lead electrocardiogram (ECG) reveals a narrow complex tachycardia with a regular rhythm, leading to a diagnosis of AV nodal reentrant tachycardia (AVNRT). Considering the patient’s condition, which of the following would be the most appropriate initial approach for acute management?

A 32-year-old man with a known history of palpitations and dizziness presents to the emergency department. Despite his efforts to control these symptoms with deep breaths and neck massages, they have escalated in severity over several hours. His current vital signs indicate a blood pressure of 60/30 mmHg and a heart rate of 220 beats per minute. An EKG reveals regular narrow-complex tachycardia (SVT). Based on his hemodynamic status and current symptoms, what is the most appropriate intervention?

A 31-year-old woman without any notable medical history reports to the emergency department. She is experiencing shortness of breath and palpitations that began rapidly when she bent down to pick up her son. She self-reported daily multivitamin and oral contraceptive use. On examination, her vital stats are: blood pressure – 128/82 mmHg, pulse – 161/min, and respirations – 16/min. An ECG reveals a regular narrow-complex tachyarrhythmia, indicative of AV nodal reentrant tachycardia (AVNRT). Carotid sinus massage and Valsalva maneuvers are performed; however, symptoms persist. What is the appropriate next step in management?

A 65-year-old male with a past medical history of hypertension, currently on amlodipine, presents to the emergency department with complaints of shortness of breath and new onset palpitations. On arrival, his vitals are as follows: BP 90/62 mm Hg, HR 165 beats/min, RR 26 breaths/min, and temperature 38.9oC. A 12-lead ECG indicates a narrow complex tachycardia with a regular rhythm, diagnosed as AV nodal reentrant tachycardia (AVNRT). Despite unsuccessful attempts with adenosine 6 mg and 12 mg (given twice) and vagal maneuvers, he continues to be symptomatic with persistent hypotension. What is the most appropriate next step in the management of this patient’s condition?