Palpitations | Figure 1

Palpitations

45 Y F presents with pvcs and near syncope, no chest pain or dyspnea
Hx Mals, Alopecia, hypotension, and palpitations
Echo is remarkable
No PVC during stress test, but there were many during recovery
IS this RVOT, LVOT, or ARVD?
What is the diagnosis for this patient and work up?

Similar cases

84 y/o Male with a recent (within 2 week) cath for a STEMI. Complaining of acute intermittent palpitations and generalized weakness. Rhythm during transport consisted of mostly ectopic beats (PVC’s, PAC’s, PJC’s). Significant right axis deviation was found and during transport, pt began to have couplets, triplets, and runs of PVC’s. Treated with a 150mg Amiodarone drip over 10 minutes during transport. Pt had no symptom changes en route and no episodes of palpitations during transport.

Should you count PVCs as part of the heart rate?

70yo male, admitted to the EP lab for PVC ablation. Sorry picture of baseline ECG, baseline was sinus with relatively frequent right sided PVCs. The above happened during pace mapping. After watching/waiting for spontaneous AV node recovery for one hour , pt. won himself a temporary pacemaker.

Case F/up: Frequent PVCs we took to EP lab. First image is how we map the PVCs using 3D mapping software to reconstruct the LV and it’s associated structures and can locate where the PVCs originate from. In this case they were Posteromedial Papillary muscle PVCs which was where ablation was performed. Not an uncommon site for ventricular arrhythmias as one of the origin sites for idiopathic VTs (along with fascicular VT, LVOT, RVOT, mitral annulus, coronary cusps).

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?