A 34-year-old male with history of Palpations came to emergency with a pulse rate 156/min and with a BP-70/40 mm Hg.Emergency crew has tried vagal maneuver and adenosine to which the rhythm is refractory. What is the next step:

Ans. (C) DC shockRef: Harrisons Principle of Internal Medicine 20th Ed; Page No-1742* ECG Findings: Typical AVNRT (SVT).* The patient is hemodynamically unstable so Shock is needed.Atrioventricular Nodal Reentrant Tachycardia (AVNRT)It is a type of supraventricular tachycardia (i.e. it originatesabove the level of the Bundle of His) and is the commonestcause of palpitations in patients with hearts exhibiting nostructurally abnormality.Slow-Fast AVNRT (Common AVNRT)* Accounts for 80-90% of AVNRT* Associated with Slow AV nodal pathway for anterogradeconduction and Fast AV nodal pathway for retrogradeconduction.* The retrograde P wave is obscured in the correspondingQRS or occurs at the end of the QRS complex as pseudo ror S waves* ECG:# P waves are often hidden - being embedded in the QRScomplexes.# Pseudo r'wave may be seen in VI# Pseudo S waves may be seen in leads II, III or aVF.* In most cases this results in a 'typical5 SVT appearance withabsent P waves and tachycardia Treatment: If unstable, cardiovert. If stable, try vagal maneuvers, IV adenosine, metropolol, or verapamil