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Gepubliceerd in: Netherlands Heart Journal 7-8/2022

Open Access 10-05-2022 | Rhythm Puzzle – Question

Swinging rhythms

Auteurs: J. Dijkmans, J.-T. Wijmenga, R. Tukkie

Gepubliceerd in: Netherlands Heart Journal | Uitgave 7-8/2022

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A 78-year-old woman receiving treatment for hypertension was admitted for diuretic therapy and rhythm monitoring after being diagnosed with congestive heart failure and atrial fibrillation. She was referred with progressive peripheral oedema and her chest radiograph showed signs of left-sided decompensation and pleural effusion. The transthoracic echocardiogram revealed severe dilated cardiomyopathy with a left ventricular ejection fraction of < 10% and severe tricuspid regurgitation.
The initial electrocardiogram (Fig. 1) showed atrial fibrillation with a ventricular rate of 168 bpm and normal QRS duration. After administration of digoxin with a total loading dose of 1 mg the ventricular rate decreased to 120 bpm. Eight hours later a broad complex tachycardia appeared on telemetric monitoring. The acquired electrocardiogram is presented in Fig. 2. Laboratory analyses revealed no evidence for electrolyte disturbances or myocardial injury. The measured digoxin plasma concentration was 1.3 µg/l (range 0.5–2.0).
What is your diagnosis? What is the most likely mechanism?

Answer

You will find the answer elsewhere in this issue.

Conflict of interest

J. Dijkmans, J.-T. Wijmenga and R. Tukkie declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.
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Metagegevens
Titel
Swinging rhythms
Auteurs
J. Dijkmans
J.-T. Wijmenga
R. Tukkie
Publicatiedatum
10-05-2022
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 7-8/2022
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-022-01694-8

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