Case 127

Abstract

A 55-year-old man was brought to the emergency department after an episode of palpitations and syncope. He had no prior cardiac history, and his medical history was significant only for hypertension, which he has been trying to manage with a salt-restricted diet. He has been quite active and denied previous symptoms of angina or heart failure. He has not been taking any medications. His symptoms started abruptly while sitting at his desk at work, and consisted of rapid palpitations with chest pain, shortness of breath, lightheadedness, and diaphoresis. A nurse was present and reported a heart rate near 200 bpm. After a few minutes, he briefly lost consciousness, then quickly awoke and felt well. He has no known history of arrhythmias, although he has had several prior episodes of palpitations in the past which have resolved spontaneously for which he had not sought evaluation. The rescue squad was called. During transport several short runs of a wide complex tachycardia were noted on monitor but no strips were saved. Upon arrival at the emergency room, his heart rate was 80, with a blood pressure of 108/72. His electrocardiogram is shown in Fig. 127.1. An echocardiogram was obtained later that day and is shown in Fig. 127.2. This led to a cardiac magnetic resonance study as shown in Fig. 127.3.