--- title: 75-year-old man with a history of hypertension description: It's Hypertension Quiz Time with Med-Challenger! image: https://challengercme.com/hubfs/Blog%20Covers/Blog%20-%2075-year-old%20man%20with%20a%20history%20of%20hypertension.png --- [![Med-Challenger-green-logo-1024x244](https://challengercme.com/hubfs/Med-Challenger-green-logo-1024x244.webp) ](https://challengercme.com/) - [SHOP EXAM PREP & CME ](https://challengercme.com/blog/75-year-old-man-with-a-history-of-hypertension#) ### [EMERGENCY MEDICINE](https://challengercme.com/emergency-medicine-exam-review-cme-course) [ABEM exam prep](https://challengercme.com/emergency-medicine-exam-review-cme-course), [MyEMCert](https://challengercme.com/emergency-medicine-myemcert-exam-review-course), etc. ### [FAMILY MEDICINE](https://challengercme.com/family-medicine-exam-review-cme-course) [ABFM exam prep](https://challengercme.com/family-medicine-exam-review-cme-course), [ABFM KSA](https://challengercme.com/family-medicine-moc-ksa-course), etc. ### [INTERNAL MEDICINE ABIM exam prep, MOC points, etc.](https://challengercme.com/internal-medicine-exam-review-cme-course) ### [OBGYN ABOG exam prep, CREOG, etc.](https://challengercme.com/obgyn-exam-review-cme-course) ### [PEDIATRICS ABP exam prep, MOCA-PEDS, etc.](https://challengercme.com/pediatric-medicine-exam-review-cme-course) ### [PEDIATRIC EM](https://challengercme.com/pediatric-emergency-medicine-3rd-edition) [ABP/ABEM exam prep Ed.3](https://challengercme.com/pediatric-emergency-medicine-3rd-edition), [Ed.2](https://challengercme.com/pediatric-emergency-medicine-pack2), etc. ### [SPECIAL PURPOSE / SPEX FSMB exam prep, etc.](https://challengercme.com/special-purpose-exam-review-spex-exam-preparation-course) ### [PHYSICIAN ASSISTANT](https://challengercme.com/physician-assistant-exam-review-cme-course) [PANCE / PANRE](https://challengercme.com/physician-assistant-exam-review-cme-course), [CAQ-EM](https://challengercme.com/pa-caq-em-review-course), etc ### [NURSE PRACTITIONER](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course) [FNP](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course), [ENP](https://challengercme.com/emergency-nurse-practitioner-exam-review-cne-course), [AGNP](https://challengercme.com/adult-gerontology-nurse-practitioner-exam-review-cne-course), [PNCB/CPNP](https://challengercme.com/pediatric-nurse-practitioner-exam-review-cne-course), etc. ### [NURSING / NCLEX NCLEX, CNE, etc.](https://challengercme.com/nursing-certification-nclex-exam-review-cne-courses) ### [STATE-REQUIRED CME / CE State CME requirements, etc.](https://challengercme.com/state-required-cme) ### [JOINT COMMISSION CME](https://challengercme.com/stroke-center-ce-review-course) [Stroke](https://challengercme.com/stroke-center-ce-review-course), [Cardiac](https://challengercme.com/cardiac-center-ce-review-course), [Trauma](https://challengercme.com/trauma-center-ce-review-course), [ALS](https://challengercme.com/advanced-life-support-and-resuscitation-center-ce-review-course), etc. ### [PROFESSIONALISM CME Professionalism review with CME](https://challengercme.com/professionalism-review-course) ### [DERMATOLOGY CME Dermatology review with CME](https://challengercme.com/dermatology-review-course) ### [USMLE STEP 2CK / STEP 3 USMLE exam prep, etc.](https://challengercme.com/usmle-certification-exam-review-clerkship-exams-shelf-exam-review) - [INSTITUTIONS ](https://challengercme.com/atlas-pro-inst) - [BLOG ](https://challengercme.com/blog) - [SUPPORT ](https://support.challengercme.com/knowledge) [SIGN IN ](https://fuse.challengercme.com/sign-in?redirectURL=%2Fuserdash) family medicine # 75-year-old man with a history of hypertension It's Hypertension Quiz Time with Med-Challenger! [ Med-Challenger ](https://challengercme.com/blog/author/med-challenger) Dec 17, 2025 [family medicine](https://challengercme.com/blog/tag/family-medicine) [Personal Education](https://challengercme.com/blog/tag/personal-education) [Question of the Week](https://challengercme.com/blog/tag/question-of-the-week) [quick quiz](https://challengercme.com/blog/tag/quick-quiz) ### < [All Posts](https://challengercme.com/blog) ABFM Exam Prep + CME Med-Challenger Family Medicine Pass-guaranteed ABFM exam review with CME built-in. Try it for free. On sale now. [START FM REVIEW](https://fuse.challengercme.com/fulltrial/198) --- ### Share this article [mailto:?subject=Check%20out%20https://challengercme.com/blog/75-year-old-man-with-a-history-of-hypertension&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/75-year-old-man-with-a-history-of-hypertension&utm_medium=social&utm_source=email](mailto:?subject=Check%20out%20https://challengercme.com/blog/75-year-old-man-with-a-history-of-hypertension&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/75-year-old-man-with-a-history-of-hypertension&utm_medium=social&utm_source=email) ### Subscribe ### Subscribe ![ECG history of hypertension](https://challengercme.com/hubfs/Blog%20Covers/Blog%20-%2075-year-old%20man%20with%20a%20history%20of%20hypertension.png) A 75-year-old man with a history of hypertension presents to you for evaluation of intermittent episodes of dizziness over the past several days. He is currently without any dizziness and notes no chest pain, shortness of breath, or focal weakness/numbness. His blood pressure today is 160/80 mm Hg. Physical examination is unremarkable except for tachycardia. He is on hydrochlorothiazide for hypertension. Electrocardiography (ECG) is obtained (see Figure). ![ECG history of hypertension](https://challengercme.com/hs-fs/hubfs/image%20(30).png?width=400&height=204&name=image%20(30).png)*Figure.* Based on the information provided, what would be the best next step in the management of this patient's condition? - emergent cardioversion - amlodipine - observation - intravenous diltiazem The correct answer is: intravenous diltiazem   This patient is presenting with symptomatic atrial flutter. Findings on ECG show evidence of atrial flutter with a 2:1 block and a ventricular rate of approximately 150 beats/minute. The next step would be to transfer the patient to the emergency department where an intravenous medication could be provided to slow the heart rate. Cardioversion is not indicated at this point as the patient is not unstable: not hypotensive, no evidence of volume overload on examination, and the patient's mentation is intact. Atrial flutter usually runs at 150 ventricular beats/minute and 300 atrial beats/minute. In children with atrial flutter, the rate may be as high as 500 atrial beats/minute. **Reference:** Yealy DM, et al. Dysrhythmias. In Marx JA, et al. *Rosen's Emergency Medicine: Concepts and Clinical Practice*. 8th ed., 2014.   This question appears in [Med-Challenger Family Medicine Exam Review with CME](https://challengercme.com/family-medicine-exam-review-cme-course) [Try for free and save](https://fuse.challengercme.com/fulltrial/198). Ace your exams and meet your CME/MOC requirements for just $35 a month! 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All rights reserved [Privacy Policy](https://support.challengercme.com/knowledge/what-are-your-terms-of-service-privacy-policy-user-agreement) ```json { "@context" : "https://schema.org", "@id" : "https://challengercme.com/blog#webpage", "@type" : "WebPage", "description" : "The Challenger Medical Education Blog offers informative patient cases, medical certification exam preparation courses and board exam review tips.", "inLanguage" : "en", "isPartOf" : { "@type" : "WebSite", "name" : "Med-Challenger", "url" : "https://challengercme.com/" }, "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog", "@type" : "WebPage" }, "name" : "Challenger Medical Education Blog", "primaryImageOfPage" : { "@type" : "ImageObject", "url" : "https://challengercme.com/hubfs/Webpage%20Featured%20Images/Medical%20Education%20Blog%20-%20Free%20CME%20resources%2c%20certification%20exam%20tips%2c%20clinical%20challenge%20questions%20and%20more.png" }, "publisher" : { "@type" : "Organization", "name" : "Challenger Corporation", "url" : "https://challengercme.com/" }, "url" : "https://challengercme.com/blog" } ``` ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "about" : [ "atrial flutter", "atrial flutter with 2:1 block", "tachycardia", "rate control", "diltiazem", "electrocardiography", "hypertension", "hydrochlorothiazide", "emergency department transfer", "medical education", "exam preparation", "family medicine review" ], "articleSection" : "Emergency Medicine", "author" : { "@type" : "Organization", "name" : "Challenger Corporation" }, "dateModified" : "2024-12-13T20:17:26.286Z", "datePublished" : "2024-12-13T20:17:25.000Z", "description" : "It's Hypertension Quiz Time with Med-Challenger!", "headline" : "75-year-old man with a history of hypertension", "image" : [ { "@type" : "ImageObject", "description" : "Challenger Corporation logo", "url" : "https://challengercme.com/logo.png" } ], "inLanguage" : "en-US", "keywords" : [ "atrial flutter", "2:1 block", "tachycardia", "diltiazem", "ECG", "hypertension", "hydrochlorothiazide", "medical education", "exam prep", "Med-Challenger" ], "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog/75-year-old-man-with-a-history-of-hypertension", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "https://challengercme.com/logo.png" }, "name" : "Challenger Corporation" } } ``` ```json { "@context" : "https://schema.org", "@type" : "QAPage", "mainEntity" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Intravenous diltiazem. The vignette represents symptomatic atrial flutter with 2:1 block and a ventricular rate of approximately 150 beats/minute. The next step is transfer to the emergency department for intravenous medication to slow the heart rate. Cardioversion is not indicated because the patient is not unstable (not hypotensive, no evidence of volume overload, and mentation intact)." }, "name" : "Best next step in management of this patient with atrial flutter?", "text" : "A 75-year-old man with a history of hypertension on hydrochlorothiazide presents with intermittent episodes of dizziness. He is currently without dizziness, denies chest pain, shortness of breath, or focal weakness/numbness. Blood pressure is 160/80 mm Hg and examination is notable for tachycardia. Electrocardiography shows atrial flutter with 2:1 block and a ventricular rate of approximately 150 beats/minute. Based on the information provided, what would be the best next step in management? Options: emergent cardioversion; amlodipine; observation; intravenous diltiazem." } } ``` ```json { "@context" : "https://schema.org", "@type" : "ItemList", "description" : "Exam-style review questions based on this article’s teaching points.", "itemListElement" : [ { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Transfer to the emergency department for intravenous rate control (intravenous diltiazem). Cardioversion is not indicated since the patient is stable (not hypotensive, no volume overload, mentation intact)." }, "name" : "What is the best immediate management for atrial flutter with 2:1 block and ventricular rate ~150?" }, "position" : 1 } ], "name" : "Practice Questions", "numberOfItems" : 1 } ```