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The Symptoms: Acute Onset Shortness of Breath, Nausea and Atrial Fibrillation

Chan, Theodore MD; Brady, William MD; Harrigan, Richard MD

doi: 10.1097/01.EEM.0000334144.78925.b7

A 50-year-old man presented to the ED complaining of acute shortness of breath and nausea over the past day. He denied chest pain, abdominal pain, vomiting, orthopnea, or PND.

The patient had recently seen his primary physician for intermittent palpitations over the past several weeks. He had a history of atrial fibrillation, hypertension, and CHF. His medications included furosemide, potassium, digoxin and aspirin daily.

On examination, the patient was in moderate distress with vital signs of pulse 106 beats/minute, blood pressure 96/52 mmHg, and respiratory rate 18 breaths/minute. His chest examination revealed clear breath sounds bilaterally. His cardiac examination demonstrated a regular tachycardia without murmurs, rubs, or gallops.

Extremity examination revealed 1+ pitting edema at the ankles bilaterally. An initial ECG was obtained (Figure 1). Within 30 minutes of arrival, the patient complained of recurrent palpitations and developed episodic hypotension. A repeat ECG was obtained (Figure 2). What is your interpretation of the ECGs and the patient's diagnosis? See p. 30.

Figure 1

Figure 1

Figure 2

Figure 2

© 2002 Lippincott Williams & Wilkins, Inc.