An Irregular Heart Beat
|These Rhythm Puzzles have been published in the Netherlands Heart Journal and are reproduced here under the prevailing creative commons license with permission from the publisher, Bohn Stafleu Van Loghum.|
|The ECG can be enlarged twice by clicking on the image and it's first enlargement|
A 71-year-old female patient presents to your outpatients clinic with an irregular heart rhythm. The complaints started a few weeks ago and seem to worsen. Her cardiac history reveals the use of digoxin prescribed by her general physician for an irregular, much faster, heart beat a few years ago. The present symptoms are different from those. Physical examination did not reveal any abnormalities except the irregular heart rhythm. Additional cardiological examinations (X-ray, echo) were without abnormalities. Part of the ECG is shown in figure 1. Only the extremity leads are shown (standard calibration).
What is your diagnosis?