Check out the latest case report from Brady Pregerson, MD. This report features a woman in her late teens presenting with palpitations and shortness of breath. Can you determine the correct diagnosis?
History: A young female in her late teens presents to the ER for episodes of palpitations and SOB lasting for 10-15 minutes occurring a few times a day for the past 4 days. She denies syncope, chest pain, fever, cough, or other complaints.
Exam: Vital signs are normal except a pulse of ~240. BP is adequate at 129/93. Exam is otherwise normal including clear lungs, no edema.
An EKG is done:
The computer read is as follows:
Rate: 244 bpm, QRS duration: 177 ms, QTc 369 ms
Uncertain regular rhythm
Intraventricular conduction delay
What should you presume as the cause and what should your treatment be?
A) SVT – modified Valsalva, adenosine, diltiazem
B) V-tach – modified Valsalva, adenosine, diltiazem
C) SVT – modified Valsalva, adenosine, procainamide
D) V-tach – modified Valsalva, adenosine, procainamide