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

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

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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