A woman in her 40s with palpitations and chest pressure of unusual etiology

Submitted and written by Magnus Nossen MD from Norway, with some minor edits by Meyers and SmithA female in her 40s with no known cardiac disease presented to the ED with palpitations and presyncopal episodes recurring over several years, usually lasting 1-5 minutes, sometimes associated with chest discomfort, and increasing in frequency over the past few months. Previously she had an echo and 5 days ambulatory ECG performed at a private clinic, both normal. The suspected arrhythmia had evaded capture. She then purchased a smart watch with the possibility for ECG recording. She presented to the emergency room with print outs recorded during palpitations. She was asymptomatic at presentation.ECG#1:ECG#1: Print out of rhythm strip from her apple watch (25mm/s). As far as one can interpret a single lead, this shows an irregular broad ventricular tachycardia with axis alternation. Duration of this episode was 90 seconds total. From this single rhythm strip differential diagnoses include atrial fibrillation with aberrant conduction/preexcitation, or polymorphic VT (which can be due to long QT, ischemic, or catecholaminergic in variety). Based on the normal beats at the end of the rhythm strip, there is no evidence of long QT. The history was not consistent with that of CPVT. She had not experienced episodes of palpitation/presyncope during physical activity. She was admitted for further work up. ECG#2:ECG#2: At rest upon admission: SR, normal interval and axes. Norm...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs