Electrocardiogram of a 46 year old man with hypertension, recently diagnosed type 2 DM, schizophrenia and life-long history of palpitations. The present episode lasted for several hours before the patient presented to the ER.
QRS 0.10 sec
QT 0.28 sec
QTc 0.48 sec
QRS axis + 10º
Interpretation: Abnormal. Supraventricular tachycardia, rate 187/min suggestive of A-V node reentrant tachycardia or orthodromic tachycardia associated with accessory pathway (antegrade conduction over the A-V node and retrograde over the accessory pathway). Non-specific repolarization abnormalities.
Hemodynamically stable. Valsalva maneuver and carotid sinus massage did not terminate the tachyarrhythmia. Given 6 mg of Adenosine iv, then 12 mg and again 12 mg with interruption of the tachycardia and restoration of regular sinus rhythm. Repeat cardiogram (below) showed pre-excitation with probable left ventricular lateral pathway. The patient was treated with Quinidine, Digoxin and Metoprolol in the past. He was advised to undergo radio-frequency ablation of the accessory pathway but is hesitant to accept this therapy.
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