The primary care NP sees a new patient for a routine physical examination. When auscultating the heart, the NP notes a heart rate of 78 beats per minute with occasional extra beats followed by a pause
History reveals no past cardiovascular disease, but the patient reports occasional syncope and shortness of breath. The NP should: a. order an ECG and refer to a cardiologist.
b. schedule a cardiac stress test and a graded exercise test.
c. order a complete blood count (CBC) and electrolytes and consider a trial of procainamide.
d. prescribe a B-blocker and anticoagulant and order 24-hour Holter monitoring.
A
Premature ventricular contractions are premature ventricular beats with a compensatory pause. This patient has no prior history, but does have syncope and shortness of breath. The NP should order an ECG and refer the patient to a cardiologist for further evaluation. If there were no other symptoms, the NP could order stress testing. Medications are not indicated without further testing and without consultation with a cardiologist.
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