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Tickling, a Technique for Inducing Positive Affect When Handling Rats
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When a little flutter gets a bit too exciting….

Mohamed Ali1, Ifeoluwade Osiyemi2, Matthew Jackson3

  • 1Internal medicine trainee, University Hospital of North Durham, Durham, UK.

Clinical Medicine (London, England)
|February 14, 2024
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Summary
This summary is machine-generated.

This case highlights that administering AV nodal blocking agents to patients with atrial flutter and pre-excitation can cause hemodynamic instability. Recognizing accessory pathways on ECG is crucial to avoid adverse drug effects.

Keywords:
Acute medicineSupraventricular tachycardiaWolf-Parkinson white syndrome

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Internal Medicine

Background:

  • Atrial flutter is a common supraventricular tachyarrhythmia.
  • Pre-excitation, characterized by an accessory pathway, can alter ventricular response during tachyarrhythmias.
  • AV nodal blocking agents are frequently used to manage tachycardias.

Observation:

  • A middle-aged man with thigh cellulitis developed palpitations and tachycardia.
  • Initial ECG revealed atrial flutter with 2:1 AV block and evidence of an accessory pathway.
  • The patient received beta-blockers (bisoprolol) to control heart rate.

Findings:

  • Beta-blocker administration resulted in 1:1 conduction of atrial flutter down the accessory pathway.
  • This led to significant hemodynamic instability.
  • The case underscores the risk of AV nodal blockade in pre-excited tachycardias.

Implications:

  • Accurate ECG interpretation to identify pre-excitation is critical before administering AV nodal blocking agents.
  • Failure to recognize accessory pathways can lead to dangerous hemodynamic compromise.
  • This case emphasizes the need for careful consideration of treatment strategies in patients with complex arrhythmias.