Palpitations in a Young Woman: What's in Your Differential?

April 1, 2014
William J. Brady, MD

The patient denies dizziness, weakness, chest pain, and dyspnea. Review case details including ECG results. What's your diagnosis?

A 27-year-old woman without significant medical history presented to the emergency department (ED) with palpitations. She said she had noted the sensation of a rapid heartbeat during the past 30 minutes. She denied syncope, dizziness, weakness, chest pain, dyspnea, or other significant complaints.

On examination, she was alert and oriented, in no apparent distress. Vital signs were significant for: blood pressure, 119/71 mmHg; pulse, approximately 180 beats/min; respiratory rate, 20 breaths/min; temperature, 36.2°C (97°F); and, oxygen saturation, 98% on room air. The ECG monitor demonstrated the rhythm strip in Figure 1. Cardiac examination found an extremely rapid, regular rhythm. The remainder of the examination was normal. A 12-lead ECG was performed; results are seen in Figure 2.

Based upon the clinical information noted in this case including the ECGs in Figures 1 and 2, the most appropriate management is:

A. Amiodarone 150 mg IV over 15 minutes.

B. Adenosine 6 mg IV push.

C. Procainamide 17 mg/kg IV over 45 minutes.

D. Electrical cardioversion at 50 joules.

Please leave your thoughts below.

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