A patient with severe uncontrolled cardiac arrhythmia is classed under which ASA grade?

• A. IV or 4
• B. II or 2
• C. III or 3
• D. V or 5

Answer: (A)

The question tests understanding of the ASA physical status classification and how life-threatening illness affects perioperative risk. An ASA IV patient has a severe systemic disease that is a constant threat to life. Severe, uncontrolled cardiac arrhythmia fits this description because it means ongoing instability of the cardiovascular system with a real risk of sudden deterioration or arrest. This goes beyond ASA II (mild systemic disease) or ASA III (severe systemic disease not life-threatening) and is more acute than the moribund scenario described by ASA V. The emergency status (E) is separate and would be added if the surgery were truly urgent or emergent, but the stem does not specify that. Therefore, this patient is classified as ASA IV.