Emergency Department Minute Quiz: Palpitations and Chest Pressure

Our latest Emergency Department Minute Quiz from Brady Pregerson, MD. Can you determine the correct diagnosis?

History: A female in her early 50’s with prior cardiac ablation for AV nodal reentrant tachycardia presents to the ED for 3 days of constant palpitations and chest pressure. She has had the same symptoms frequently for over 6 months and two ablations have not helped. She states that her heart rate is normally in the 120s at rest but recently has been in the 140s-150s. She denies fever, syncope, leg pain or swelling or other complaints.

Exam: Vital signs are normal except for a pulse of 155. Exam is otherwise normal.

An EKG is done


Atrial Flutter with rapid ventricular response

Indeterminate axis


What is the most likely diagnosis?

  1. Atrial fib with RBBB
  2. Atrial flutter with 2:1 conduction and RBBB
  3. Sinus tach with RBBB
  4. SVT with aberrancy