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A challenging broad-complex tachycardia.

Nithin Ramesh Iyer1, Adrianus W G J Oomen1, Raymond W Sy1,2

  • 1Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.

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|June 27, 2018
PubMed
Summary
This summary is machine-generated.

A patient with rapid heart rate and chest pain was treated with amiodarone. The next diagnostic step for this cardiac arrhythmia needs careful consideration to determine the best course of action.

Keywords:
Broad complex tachycardiaadenosine

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Area of Science:

  • Cardiology
  • Electrophysiology

Background:

  • A 53-year-old male presented with acute chest pain, palpitations, and presyncope.
  • The patient had no prior history of cardiac disease but presented with a heart rate of 206 bpm and blood pressure of 100/50 mmHg.

Purpose of the Study:

  • To determine the most appropriate next diagnostic test for a patient presenting with a wide complex tachycardia.
  • Evaluate diagnostic options including electrophysiology study, coronary angiography, 12-lead ECG with posterior leads, and bedside adenosine challenge.

Main Methods:

  • Intravenous amiodarone 150 mg was administered in the emergency department.
  • Electrocardiograms (ECGs) were obtained before and after amiodarone administration.
  • Echocardiography revealed low-normal left ventricular systolic function.

Main Results:

  • The patient's presentation included hemodynamic instability (tachycardia and borderline hypotension).
  • Amiodarone was administered, and ECGs were compared pre- and post-treatment.
  • Echocardiography showed preserved left ventricular systolic function.

Conclusions:

  • The case highlights the diagnostic challenge in managing patients with undifferentiated wide complex tachycardia.
  • The choice of the next diagnostic test is critical for accurate diagnosis and subsequent management of the cardiac arrhythmia.