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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.


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--> 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?

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