Professional and Linguistic Assessments Board (PLAB) Practice Exam

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What is the second-line treatment for Stable Ventricular Tachycardia (SVT) if vagal maneuvers are ineffective?

Adenosine
Calcium Channel Blockers
Beta Blockers
Amiodarone

The correct answer is: Adenosine

In the management of Stable Ventricular Tachycardia (SVT), if vagal maneuvers fail to restore normal heart rhythm, the next step typically involves pharmacological intervention. Adenosine is commonly utilized as it acts rapidly to interrupt the reentrant pathways in the atrioventricular (AV) node, effectively terminating an SVT episode. When adenosine is administered, it temporarily blocks conduction through the AV node, which can restore sinus rhythm. This is particularly effective for certain types of SVT, especially those involving reentry circuits in the atria or AV node. While other medications such as calcium channel blockers and beta blockers can also be used in managing SVT, they are generally considered when adenosine is ineffective or in cases of more chronic management rather than acute termination of an SVT episode. Likewise, amiodarone is typically reserved for more complicated cases, particularly when there is a need for rhythm control in patients who have structural heart disease or when more advanced pacing strategies are indicated. Therefore, the administration of adenosine is an appropriate second-line response following ineffective vagal maneuvers, effectively addressing the immediate need for rhythm stabilization in SVT.