Rhythm Nation- July 2015

by GuyCarmelli • July 10, 2015 • Comments Off

Hello Blog nation!

Please enjoy this month’s EKG blog post! Also, seniors, please see below for a hint, just for you ;). Here is the case:

58 yo M with h/o mitral valve prolapse p/w acutely worsening palpitations, dyspnea on exertion & lightheadedness x 4 days. Palpitations previously occurred intermittently, but are now constant. No chest pain, no syncope, no F/C, no toxic habits, no N/V/D, pt has otherwise been well.

V/S: HR 200, BP 140/89, RR 18, 100% on RA, T 97.5

–Appears anxious, A&Ox3

–HEENT: normal

–CV: tachy, no murmurs, symmetric pulses

–Resp: CTAB

–Abd: soft NTND

–Extrem: nontender, no edema

Questions:

What is the differential for coupled beats?

What is the underlying rhythm (describe in detail)?

Describe any associated features (ST-T changes, QRS morphology…etc) and what, if any, clinical consequence they represent.

What diagnostic modalities can further help you categorize this rhythm?

What are temporary and definitive treatments for this rhythm?

Thanks guys and good luck!

Sincerely,

Guy Carmelli

P.S. Senior Hint- see image below

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.