Tachyarrhythmia short case Dr. Jane Nader

short cases for medical students

1. SHORT CASES
TACHYARRHYTHMIA
JANE NADER, MD
BUC

2. Case 1

3. History
A 16-year-old female was seen in primary care clinic presenting with 9-year history
of palpitation of fast heartbeats of sudden onset and which used to stop abruptly.
She was reassured that her racing heart is mostly due to stress and anxiety.
However, For the last 3 months, her condition worsened as she started to have
shortness of breath, giddiness, and fatigue. Most of these attacks were triggered
with efforts like climbing stairs, and recently over the last few days, the attacks
were triggered when she eats or drinks. She was not on any medication. Her past
medical history was unremarkable.

4. Examination
Vital signs: weight 51 kg, height 157 cm, and blood pressure of 112/64 mmHg.
On examination: pulse 94 (BPM) and regular, no signs of anemia or hyperthyroidism,
cardiovascular: normal heart sounds and no added murmur; chest and abdomen were normal.

5. Q. What is your differential diagnosis
Sinus tachycardia
Supraventricular tachycardia
Atrial fibrillation

6. Q. What should you order?
ECG
CBC
Thyroid functions
Electrolyte panel
Blood sugar
+ ECG
+ Echo

7. •ECG showed a regular sinus rhythm with a rate of 120bpm
•Echo was normal

8. Case 2

9. A 63-year-old gentleman who was diagnosed with atrial fibrillation and an
associated rapid ventricular response in 2013. He was successfully treated with
metoprolol as well as apixaban.
1 week ago, he began to experience symptoms of persistent heart
palpitations.
ECG was done and showed atrial fibrillation with heart rate 110 bpm

10. What is your
plan?
What other
investigations to
be done?

11. PLAN
Rhythm control
DC
cardioversion
Pharmacological
cardioversion
Rate control Continue on AF

12. DC Cardioversion was unsuccessful; therefore, medical
cardioversion was attempted with a trial of oral sotalol, IV
diltiazem and overnight observation.
Sinus rhythm was achieved several hours after initiation of
therapy with regular ventricular rate. He was discharged and was
advised to follow up after 4 weeks.

13. Medications on discharge??

14. Medications on discharge
Sotalol and diltiazem to maintain
the sinus rhythm
Abixabanfor anticoagulation

15. THANK YOU