Alexander P Hoffmann, Elliot J Stein, Neal A Chatterjee
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A diagnostically challenging case of wide complex tachycardia
A woman in her 60s with non-obstructive coronary artery disease, aortic valve replacement and aortic arch repair, chronic diastolic heart failure and paroxysmal atrial fibrillation (AF) and flutter (AFL), presented with 3 days of sustained palpitations that felt similar to prior episodes of AF/AFL. She was euvolemic, haemodynamically stable, with a regular rhythm. Home medications included apixaban, carvedilol and flecainide. Presenting ECG (figure 1A) was compared with baseline ECG (figure 1B) and ECG from a recent admission for AF with rate-related aberrancy (figure 1C). There was no atrioventricular dissociation or fusion/capture beats. High-sensitivity troponin I was undetectable. Serum creatinine had fluctuated recently between 1.3 and 2.0 mg/dL from a baseline of 1.0 mg/dL (estimated glomerular filtration rate approximately 25–45 from a baseline of >60 mL/min/1.73 m2). Electrolytes …
期刊介绍:
Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.