USMLE Step 3 - Question 17

A 67 year old male with a history of severe chronic obstructive pulmonary disease (COPD), hypertension, and congestive heart failure presents to the emergency room with increasing shortness of breath over the past week. He denies any chest pains or fevers. His temperature is 37.0 C, blood pressure 130/70, heart rate 120, respirations 24, and oxygen saturation 87% on room air. Physical examination reveals diffuse expiratory wheezing without rales, heart sounds are normal without murmurs and an irregularly irregular rhythm is noted. There is trace lower extremity pitting edema. Laboratory studies reveal a mildly elevated b-type natriuretic peptide and an elevated white blood cell count. His chest x-ray shows hyperexpanded lungs and no evidence of pulmonary edema. His ECG is below. What is the appropriate treatment for his heart rhythm disorder?

MAT

A. Propranolol

B. Verapamil

C. Amiodarone

D. No specific medication treatment

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