Emergency Department Minute Quiz: Palpitations and Chest Pressure

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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

EKG

COMPUTER EKG READ:

Atrial Flutter with rapid ventricular response

Indeterminate axis

RBBB

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

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