Emergency Department Minute Quiz: Palpitations and Chest Pressure

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

COMPUTER EKG READ:

Atrial Flutter with rapid ventricular response

Indeterminate axis

RBBB