Case Report: Palpitations and Shortness of Breath

Brady Pregerson, MD

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