ECG Challenge: Double trouble

The patient appears anxious. His skin is pink, warm and moist. He states that his palpitations have "never been this bad" before.


Editor’s Note:

Editor's Note: Check out this month's ECG case study and submit your treatment plan in the comments below. Get it right and you could win an EMS1 T-shirt and bottle opener. Good luck!

--> UPDATED: 11/22/2011 - Patient Follow-Up Posted. CLICK HERE FOR THE ANSWER

EMS is called to the residence of a 57-year-old male complaining of palpitations.

Past medical history: Palpitations "on and off" for the past two months. He was seen by a doctor and prescribed some medications.

Medications: Digoxin (Lanoxin) 0.125 mg, Propafenone (Rhythmol) 150 mg.

No known drug allergies.

The patient appears anxious. His skin is pink, warm and moist. He states that his palpitations have "never been this bad" before.

He denies chest discomfort or shortness of breath.

Breath sounds are clear bilaterally.

No JVD or pitting edema.

Vital signs are assessed.

  • RR: 18 
  • Pulse: Very rapid
  • NIBP: 110/78
  • SpO2: 100 on room air

The patient is placed on the cardiac monitor which shows a narrow complex tachycardia at a rate of 261.

A 12-lead ECG is captured with the following computer measurements.

HR: 132
PR: 140
QRS: 94
QT/QTc: 290/416
P-QRS-T: -98 30 -78

How do you account for the difference in rate between the rhythm strip and the 12-lead ECG?

How would you treat this patient and why?

About the author

Tom Bouthillet is a Fire Captain/Paramedic with Hilton Head Island Fire & Rescue, Editor-in-Chief of the EMS12Lead.com, Chief Content Architect of ECGMedicalTraining.com, host of the Code STEMI web series at First Responders Network, a member of the Editoral Advisory Board of EMS World Magazine, and developer of the 12-Lead ECG Challenge smartphone app. He has taught nationally in the Critical Care Transport (CCEMT-P) program out of UMBC and his writings have been referenced in the American Heart Journal, the Journal of the American College of Cardiology: Cardiovascular Interventions and the EP Lab Digest. Contact Tom at tom.bouthillet@ems1.com.

  1. Tags
  2. Cardiac Care
  3. Medical / Clinical

Recommended Cardiac Care

Join the discussion