A nurse is caring for a client who has Meniere’s disease. The nurse identifies that which of the following manifestations is caused by an excessive accumulation of endolymph fluid?

A. Synchronized electrical cardioversion: Synchronized electrical cardioversion is a procedure used to restore normal sinus rhythm in patients with certain types of arrhythmias, such as atrial fibrillation or atrial flutter. However, it is not typically indicated for all patients with worsening heart failure and arrhythmias.

B. Cardiac resynchronization therapy (CRT): CRT, also known as biventricular pacing, involves the placement of a specialized pacemaker device to improve the coordination of contractions between the heart's chambers. It is often used in patients with heart failure and arrhythmias to help regulate the rhythm and improve cardiac function.

C. Heart catheterization with percutaneous intervention: Heart catheterization with percutaneous intervention, such as angioplasty or stent placement, is used to treat coronary artery disease by opening narrowed or blocked blood vessels. While coronary artery disease may contribute to heart failure, this procedure specifically targets the coronary arteries rather than arrhythmias.

D. Echocardiogram : An echocardiogram is a diagnostic test that uses sound waves to create images of the heart's structure and function. While an echocardiogram may provide valuable information about the heart's condition in a patient with heart failure and arrhythmias, it is not a procedure used to regulate the rhythm directly.

A) Computed tomography (CT) scan: A CT scan may provide detailed images of the heart and surrounding structures, but it is not typically the initial diagnostic test used to assess for cardiac tamponade. CT scans are often used in conjunction with other diagnostic tests but are not the first-line investigation for suspected tamponade.

B) Chest x-ray: While a chest x-ray may show signs of cardiac tamponade, such as an enlarged cardiac silhouette or evidence of fluid accumulation around the heart, it is not as sensitive or specific as other diagnostic tests, particularly in the acute setting. Chest x-rays may be obtained as part of the diagnostic workup, but they are not the first-line test for suspected tamponade.

C) Echocardiogram: An echocardiogram is the most appropriate initial diagnostic test for suspected cardiac tamponade. It provides real-time imaging of the heart and can detect pericardial effusion, collapse of the right atrium and ventricle during diastole (diastolic collapse), and signs of hemodynamic compromise. Echocardiography allows for rapid assessment at the bedside and can guide immediate management decisions.

D) Electrocardiogram (ECG): While an electrocardiogram may show nonspecific changes in cardiac tamponade, such as low-voltage QRS complexes or electrical alternans, it is not as sensitive or specific as an echocardiogram for diagnosing tamponade. ECG findings may support the diagnosis but are not typically the first-line test for suspected tamponade.