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27-10-2017 | Rhythm Puzzle - Question | Uitgave 2/2018 Open Access

Netherlands Heart Journal 2/2018

An irregular atrial tachycardia

What is the underlying mechanism?

Tijdschrift:
Netherlands Heart Journal > Uitgave 2/2018
Auteurs:
S. Pagano, G. Aguglia, D. Noto, M. Averna
A 66-year-old male patient with a history of rheumatoid arthritis, coronary artery disease, hypothyroidism, end-stage renal disease and receiving haemodialysis presented to the emergency department with palpitations. His medication was acetylsalicylic acid, pantoprazole, levothyroxine, and paracetamol and ibuprofen as needed. Laboratory test results showed a mild anaemia and serum potassium levels within the upper limit of normal. A 12-lead electrocardiogram was recorded (Fig.  1). The electrocardiogram shows narrow QRS complexes (0.08 sec) with a QS morphology in leads V1 through V4 consistent with an old antero-septal wall myocardial infarction. The rhythm is irregular at an average rate of 79 beats per minute with groups of beatings separated by pauses. However, the underlying rhythm is not a sinus rhythm.

Question

What is the mechanism?

Answer

You will find the answer elsewhere in this issue.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

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