History of Present Illness:
A woman in her early 50’s with COPD and HTN on HCTZ presents with 6 hours of right-sided pleuritic chest pain, SOB and palpitations.
Vital Signs & Physical Exam:
Vital signs are normal except for HR 160. Physical exam is otherwise normal
An ECG is done
Computer Read: Atrial flutter with RVR, ST elevation, consider inferior injury
What is the most likely cause of the ECG findings in this patient?
- A) Anxiety/Panic
- B) Blood clot (PE)
- C) Cardiac: ACS
- D) Drug toxicity
- E) Electrolyte abnormality
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My ECG interpretation: Atrial flutter with variable block (mostly 2:1 but some 3:1) with RVR. No ST findings that aren’t likely just due to atrial flutter
QUIZ ANSWER: What is the most likely cause of the ECG findings in this patient?
- A) Anxiety/Panic – always a diagnosis of exclusion
- B) Blood clot (PE) – possible but rare cause of flutter, however clinical presentation requires a rule out
- C) Cardiac: ACS – possible but rare cause of flutter
- D) Drug toxicity – possible but rare cause of flutter
- E) Electrolyte abnormality – CORRECT – common trigger/contributor to flutter and common side effect of diuretics like HCTZ
1-Minute Consult on this topic: Click HERE and scroll to proper page
Case Outcome:
- Troponin-i and repeat normal
- CT angio chest normal
- Mg = 1.3, K = 3.0