14-A 70-year-old man presents with dyspnea, fatigue and presyncope. On examination, the JVP showed Cannon a-wave and variations in the intensity of the first heart sound. Which of... 14-A 70-year-old man presents with dyspnea, fatigue and presyncope. On examination, the JVP showed Cannon a-wave and variations in the intensity of the first heart sound. Which of the following is the definitive treatment? A. Implantable cardioverter defibrillator B. Permanent pacemaker C. Oral theophylline D. Oral metoprolol
Understand the Problem
The question is asking for the definitive treatment option for a 70-year-old man who exhibits specific cardiac signs and symptoms (dyspnea, fatigue, presyncope, Cannon a-wave in the JVP, and variations in the intensity of the first heart sound). This suggests a problem related to heart rhythm or conduction, and the options provided are various medical treatments.
Answer
Permanent pacemaker
The definitive treatment for the patient is a permanent pacemaker.
Answer for screen readers
The definitive treatment for the patient is a permanent pacemaker.
More Information
Cannon A-waves with variable intensity of the first heart sound in a 70-year-old man suggest complete heart block, for which a permanent pacemaker is the definitive treatment.
Tips
A common mistake is to confuse it with the need for an implantable cardioverter defibrillator, which is for different conditions involving risk of sudden cardiac death.
Sources
- Cannon waves in atrioventricular nodal re-entry tachycardia - PMC - pmc.ncbi.nlm.nih.gov
- Extreme “cannon A waves” and pulsatile skin color in complete heart ... - pmc.ncbi.nlm.nih.gov
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