Refractory narrow complex tachycardia in pregnancy

Case A woman in her early 30s self-presents to her local ED at 03:00 hours and is brought from triage to resus due to a tachycardia of 220 beats per minute (bpm). She is 15 weeks into her first (twin) pregnancy, has no medical history and takes no regular medication. She reports a 2-day history of intermittent ‘palpitations’ which are now constant. She describes feeling presyncopal on standing with some mild chest discomfort and shortness of breath. Examination is unremarkable other than a tachycardia. Other vital signs are BP 93/67 mmHg, RR 24 breaths per minute, SpO2 99% on room air and temperature 36.3°C. An ECG (figure 1) is performed and intravenous access is obtained. Question 1: What does this ECG show and how does her pregnancy affect your initial management? Answer 1: A regular, narrow complex tachycardia. In V2, there appear to be p waves...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: SAQs Source Type: research