“Dysrhythmias in the ED…” Case Conclusion
February 6, 2013
Posted by Andy Jagoda, MD in: Cardiovascular , trackback
The morning shift in the ED has just started and the nurse approaches about an 85-year-old male from a nursing home who is febrile to 39.5°C, is tachycardic with a heart rate of 160 beats/min, and has a blood pressure of 98/57 mm Hg. He has a history of dementia, diabetes, and hypertension and is nonverbal at baseline. He is minimally responsive and unable to give additional information. You begin fluid resuscitating him and administer acetaminophen, and you notice on the monitor that his heart rhythm is irregular.
The first patient’s ECG (shown below) shows AF with preexcitation consistent with Wolff-Parkinson-White syndrome. Because the patient was hemodynamically stable, you obtained 2 large-bore peripheral IV lines and began an infusion of procainamide, coadministering a normal saline bolus. She converted to normal sinus rhythm and felt much improved, with normal repeat vital signs. Her repeat ECG showed a short PR interval with delta waves. She had no prior history of this, no past medical history, and a CHADS2 score of 0. You consulted cardiology for an electrophysiology study, and she was successfully ablated and discharged home.
Image used with permission of www.ecglibrary.com
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