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Symptoms: A Wide Complex Tachycardia

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

Cases in Electrocardiography

Dr. Harrigan is an associate professor of emergency medicine and the associate research director in the department of emergency medicine at Temple University Hospital and School of Medicine in Philadelphia; Dr. Chan is an associate professor of clinical medicine, emergency medicine, the director of CQI, and the associate medical director of the department of emergency medicine at the University of California, San Diego; and Dr. Brady is an associate professor and the program director in the department of emergency medicine at the University of Virginia School of Medicine in Charlottesville.

A 26-year-old man without medical history presented to the ED with weakness, near-syncope, and dyspnea. Initial examination revealed a young adult male in mild respiratory distress.

His vital signs were blood pressure, 100/60 mmHg; pulse, 210 beats per minute; and respiratory rate, 32 breaths per minute.

Cardiac monitor in lead II demonstrated an irregular wide complex tachycardia with a ventricular rate of approximately 210/min (Figure 1). A 12-lead ECG (Figure 2) revealed a similar rhythm: the ECG was interpreted as atrial fibrillation with rapid ventricular response. The patient was treated with 5 mg verapamil intravenously.

Figure 1

Figure 1

Figure 2

Figure 2

© 2003 Lippincott Williams & Wilkins, Inc.