A patient undergoes a routine electrocardiogram (ECG), which reveals occasional premature ventricular contractions that are present when the patient is resting and disappear with exercise
The patient has no previous history of cardiovascular disease, and the cardiovascular examination is normal. The primary care NP should: a. prescribe quinidine (Quinidex Extentabs).
b. tell the patient that treatment is not indicated.
c. refer the patient to a cardiologist for further evaluation.
d. consider using amiodarone if the patient develops other symptoms.
B
The most important factor in determining whether to treat premature ventricular contractions is the presence of underlying heart disease, such as myocardial ischemia, previous myocardial infarction, cardiac scarring or hypertrophy, or left ventricular dysfunction. Because of the risks associated with antiarrhythmic therapy, patients should not be treated unless clear indications are present. Premature ventricular contractions are not treated if the patient is asymptomatic, if the patient has a normal heart, if the premature ventricular contractions are simple, and if they disappear with exercise. Amiodarone is not used to treat acute premature ventricular contractions but is used for long-term prophylaxis.
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