Enunciado A 68-year-old male was admitted at the emergency department complaining of sudden intermittent episodes of intense uneasiness, blurred vision and sense of imminent death which had begun 10 days before, lasted only a few seconds and recurred about 6 times a day. The patient reported having had a similar episode 6 months before. He had previous history of hypertension, Chagas disease, severe persistent asthma and diabetes mellitus and was taking Budesonide + Formoterol 400mcg+12mcg twice a day, Montelukast 10mg, Salbutamol 100mcg/puff as a rescue medication, Hydrochlorothiazide 25mg, Glibenclamide (Glyburide) 5mg, Losartan 50mg twice a day and Metformin 850mg. On physical examination it was observed: BP: 160/90 mmHg, PR: 95/min, RR: 20/min, normal breath sounds, regular heart rhythm and rate, normal heart sounds without murmurs, a soft and non-tender abdomen and absence of peripheral edema. The patient was monitored and evaluated with serial ECG (Images 1 and 2) and chest radiography (Image 3). He then experienced another acute episode of discomfort with simultaneous ECG recording (Image 4). (1) First electrocardiogram performed. (2) Second ECG performed. (3) Posteroanterior and lateral chest radiograph. (4) ECG obtained during acute episode of discomfort experienced after admission.Image 2: Second ECG performedImage 3: Posteroanterior and lateral chest radiographImage 4: ECG obtained during acute episode of discomfort experienced after admission Question:Based on the clinical history and images provided, one can assume that: The patient might be diagnosed with paroxysmal atrial fibrillation and a beta-blocker is considered the drug of choice for rate control. The episode of discomfort experienced after admission might be attributed to ventricular tachycardia and prompt electrical cardioversion is indicated. The episode of discomfort experienced after admission might be attributed to non-sustained ventricular tachycardia and amiodarone is the treatment of choice. The episode of discomfort experienced after admission might be attributed to atrial fibrillation with rapid ventricular response and electrical cardioversion is indicated. Time is Up! Time's up
