Advanced Cardiovascular Life Support (ACLS) Practice Exam

Under what circumstances should cardioversion be considered for persistent tachycardia?

1. Presence of a wide QRS complex

2. Causing chest pain

3. Both hypotension and altered mental status

4. Only altered mental status

The correct answer is: Both hypotension and altered mental status

Cardioversion is a critical intervention used in the management of persistent tachycardia, particularly when it poses an immediate threat to the patient's hemodynamic stability. The correct choice highlights that the presence of both hypotension and altered mental status are crucial indicators for considering cardioversion. Hypotension indicates that the heart is unable to maintain sufficient blood pressure, which can lead to inadequate perfusion of vital organs and subsequent organ dysfunction. Altered mental status, which could manifest as confusion, disorientation, or decreased responsiveness, often suggests cerebral hypoperfusion due to insufficient blood flow. The combination of these two factors signifies a severe compromise in the patient's hemodynamic status. In general, addressing life-threatening arrhythmias promptly is a priority in advanced cardiovascular life support (ACLS). Cardioversion can restore normal rhythm and improve heart function, thus addressing both hypotension and altered mental status effectively. While a wide QRS complex may indicate a potentially serious arrhythmia, it does not independently determine the need for immediate cardioversion without the presence of symptoms related to instability. Similarly, chest pain is a significant symptom that may warrant intervention but does not alone dictate the use of cardioversion, as it is essential to assess the overall clinical picture