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Shock first, ask questions later….

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A young man with a history of an undiagnosed heart condition experienced sudden palpitations and hypotension. This case highlights the importance of investigating childhood cardiac anomalies, even if previously dismissed.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Emergency Medicine

Background:

  • A 39-year-old male with no prior cardiac history presented with acute onset palpitations.
  • Patient reported a childhood diagnosis of an 'extra bit of wiring in his heart' without further follow-up.
  • Relevant medical history included Sertraline use and excessive alcohol consumption.

Observation:

  • The patient presented to the Emergency Department with sudden, hour-long palpitations, feeling clammy and unwell.
  • On examination, he was hypotensive and pain-free.
  • Laboratory results showed normal potassium and magnesium levels, with a mildly elevated venous lactate (2.8).

Findings:

  • The presentation suggests a potential supraventricular tachyarrhythmia, possibly related to an underlying accessory pathway (Wolff-Parkinson-White syndrome).
  • Hypotension in the context of palpitations indicates hemodynamic compromise.
  • Mildly elevated lactate may reflect reduced cardiac output or stress response.

Implications:

  • This case underscores the critical need for thorough cardiac evaluation in individuals with a history of congenital heart anomalies, even if asymptomatic for years.
  • Prompt recognition and management of tachyarrhythmias causing hemodynamic instability are crucial in the emergency setting.
  • Further investigation, including electrocardiogram (ECG) and potentially electrophysiology study, is warranted to confirm the diagnosis and guide long-term management.