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Open Access 20-01-2017 | Rhythm Puzzle - Question

Broad complex rhythm with a salty taste

Auteurs: M. Boulaksil, C. L. Meuwese, R. Evertz, M. G. M. Kolff-Kamphuis

Gepubliceerd in: Netherlands Heart Journal | Uitgave 5/2017

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A 65-year-old female patient with a medical history of stroke and paroxysmal atrial fibrillation presented to the neurologist at the emergency department of our hospital because of progressive weakness, dyspnoea, and fatigue. Her fluid intake had been minimal because of her malaise. She had no history of syncope. She used the following medications: warfarin, flecainide, and metoprolol. Initial physical examination showed a blood pressure of 105/65 mmHg, a heart rate of 90/min, and no fever. She was clinically mildly decompensated: she had bilateral pulmonary rales and ankle oedema. A CT scan of the brain did not show any significant abnormalities. Laboratory results showed: creatinine 108 µmol/l; MDRD-GFR 44 ml/min; sodium 137 mmol/l; potassium 5.3 mmol/l; calcium 2.2 mmol/l; and magnesium 0.87 mmol/l.
Fig. 1 shows the initial ECG on admission. After taking her daily medication at the emergency department, the ECG evolved to Fig. 2. Eventually, she was admitted to the cardiac care unit.
What is your (differential) diagnosis?

Answer

You will find the answer elsewhere in this issue.
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Metagegevens
Titel
Broad complex rhythm with a salty taste
Auteurs
M. Boulaksil
C. L. Meuwese
R. Evertz
M. G. M. Kolff-Kamphuis
Publicatiedatum
20-01-2017
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 5/2017
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-017-0950-y