Rosh Internal Medicine Boost Practice Exam

What treatment was attempted first before identifying the next best treatment?

1. Cardioversion

2. Vagal maneuvers

3. Medication therapy

4. Fluid resuscitation

The correct answer is: Vagal maneuvers

Vagal maneuvers are often the initial treatment attempted for certain types of supraventricular tachycardia (SVT), particularly to slow down the heart rate or restore normal rhythm without the need for medications or electrical therapies. These maneuvers can include actions such as the Valsalva maneuver or carotid sinus massage, both of which increase parasympathetic tone and can help terminate an SVT episode. If vagal maneuvers are ineffective, the next steps generally involve considering other interventions, such as medication therapy or cardioversion, especially if the patient is hemodynamically unstable. The non-invasive nature and simplicity of vagal maneuvers make them the preferred first step in a stable patient with SVT. In the context of acute management, fluid resuscitation is not typically the first approach for arrhythmias unless there is concurrent hypovolemia or shock, while medication therapy might be introduced soon after vagal maneuvers if they do not resolve the issue. Cardioversion is reserved for cases of severe instability or when other methods have failed. Thus, vagal maneuvers serve as an effective initial intervention leading to subsequent treatment options.