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Answer Rhythm Puzzle 2004 10 469: Difference between revisions
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Answer Rhythm Puzzle 2004 10 469 (view source)
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[[Image:Puzzle 2004 10 469 | [[Image:Puzzle 2004 10 469 fig1.png|Figure 1|thumb]] | ||
[[Image:Puzzle 2004 10 469 fig2.jpg|Figure 2|thumb]] | |||
A 27-year-old female was referred to the emergency room with rapid palpitations. The ECG at presentation is shown in figure 1. The tachycardia did not respond to carotid sinus massage. A bolus of 6 mg intravenous adenosine terminated the tachycardia and restored sinus rhythm (figure 2). Cardiological evaluation including echocardiography revealed no abnormalities. Over the last few years, the patient had previous episodes of rapid palpitations lasting 15 to 20 minutes occurring once or twice a week. The paroxysms recurred despite treatment with sotalol, flecainide, and propafenone. The patient was referred for electrophysiological study (EPS) and radiofrequency catheter ablation (RFCA) if possible. | A 27-year-old female was referred to the emergency room with rapid palpitations. The ECG at presentation is shown in figure 1. The tachycardia did not respond to carotid sinus massage. A bolus of 6 mg intravenous adenosine terminated the tachycardia and restored sinus rhythm (figure 2). Cardiological evaluation including echocardiography revealed no abnormalities. Over the last few years, the patient had previous episodes of rapid palpitations lasting 15 to 20 minutes occurring once or twice a week. The paroxysms recurred despite treatment with sotalol, flecainide, and propafenone. The patient was referred for electrophysiological study (EPS) and radiofrequency catheter ablation (RFCA) if possible. | ||
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==Answer== | ==Answer== | ||
Figure 1 shows a wide-QRS tachycardia (QRS duration 120 ms, rate 150 beats/min) with complete right bundle branch block (RBBB) morphology, and a (slight) leftaxis deviation. Lead V6 shows an RS configuration. P waves are not discernible. Signs suggestive of both ventricular and supraventricular origin are present. The tachycardia was terminated by adenosine. This is (usually) suggestive of a supraventricular origin. The ECG after conversion (figure 2) shows an incomplete RBBB and | Figure 1 shows a wide-QRS tachycardia (QRS duration 120 ms, rate 150 beats/min) with complete right bundle branch block (RBBB) morphology, and a (slight) leftaxis deviation. Lead V6 shows an RS configuration. P waves are not discernible. Signs suggestive of both ventricular and supraventricular origin are present. The tachycardia was terminated by adenosine. This is (usually) suggestive of a supraventricular origin. The ECG after conversion (figure 2) shows an incomplete RBBB and | ||