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a young man with palpitations

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a young man with palpitations

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This young man (aged 24) presented to A&E with palpitations. I thought his ecg was rather interesting.

Cat:OpenClinicalForum:083a12c9-861a-4a42-a5af-ddc3263b34bc

Cat:OpenClinicalForum:083a12c9-861a-4a42-a5af-ddc3263b34bcDiscussion:12ee73df-a055-4f9e-8b3f-67a3811d5dba

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Forums » Open clinical » Cardiology » a young man with palpitations

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Forums » Open clinical » Cardiology » a young man with palpitations

a young man with palpitations

posted at 15/7/2011 4:15 PM BST on bmj.com

sadian

Posts: 878
First: 17/6/2011
Last: 24/5/2013

This young man (aged 24) presented to A&E with palpitations. I thought his ecg was rather interesting.

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Re: a young man with palpitations

posted at 16/7/2011 2:40 PM BST on bmj.com

Deb_D

Posts: 492
First: 12/7/2010
Last: 7/5/2013

Can some thing please be done about the size of the images? Even with zooming I am having difficulty in properly visualizing the ECG.

I assure everyone that its not an excuse for not being able to interpret the ECG

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Re: a young man with palpitations

posted at 16/7/2011 3:09 PM BST on bmj.com

ranasaleem

Posts: 220
First: 10/12/2010
Last: 1/6/2012

Heart rate is 150/m; regualr
No p waves.
J point needs to be interpreted by an ECG.
Start with BB. If patietn is anxious, give benzodiazepines also.
If there is a murmur, send for XR chest and echocardiography.

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Re: a young man with palpitations

posted at 18/7/2011 8:45 AM BST on bmj.com

sadian

Posts: 878
First: 17/6/2011
Last: 24/5/2013

Sorry I can't do anything with the qualtiy of the ecg. Some more clinical details might be useful to you. He is visting the UK on a student visa from Pakistan - he had an echo there about 2 weeks before he came over and was told that his heart was enlarged.

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Re: a young man with palpitations

posted at 22/7/2011 4:53 PM BST on bmj.com

sadian

Posts: 878
First: 17/6/2011
Last: 24/5/2013

The ecg shows electrical alternans - I think it is best seen in V3. He had a large pericardial effusion and we drained about 1l. The working diagnosis was of TB.

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Re: a young man with palpitations

posted at 22/7/2011 6:39 PM BST on bmj.com

panos

Posts: 187
First: 11/3/2009
Last: 14/10/2012

Very interesting Sadian! I think you should publish it!

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Re: a young man with palpitations

posted at 25/7/2011 8:38 AM BST on bmj.com

sadian

Posts: 878
First: 17/6/2011
Last: 24/5/2013

Thank you - i'm glad you found it interesting - he has a classical CXR of pericardial effusion also but unfortunately all the admitting team saw was the AF!
best,
sadian

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Re: a young man with palpitations

posted at 27/7/2011 2:35 PM BST on bmj.com

Dean Jenkins

Posts: 195
First: 14/1/2009
Last: 17/5/2013

Here's another example of electrical alternans.

http://ecglibrary.com/elec_alt.html

Agree it's hard to see the ECGs on doc2doc

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Re: a young man with palpitations

posted at 16/8/2011 8:50 AM BST on bmj.com

drbanon

Posts: 33
First: 11/2/2011
Last: 2/5/2013

I agree this should be a good case for publishing. Both the EMJ and BMJ have short case reports now. I suspect the angle you should adopt is the 'differential diagnosis' of electrical alternans (which is essentially caused by excessive movement of the heart), therefore Pericardial effusion should certainly be considered.

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Re: a young man with palpitations

posted at 16/8/2011 8:52 AM BST on bmj.com

drbanon

Posts: 33
First: 11/2/2011
Last: 2/5/2013

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