A 28-Year-Old Woman Comes to the Emergency Department Due to the Abrupt

question 443

Multiple Choice

A 28-year-old woman comes to the emergency department due to the abrupt onset of palpitations that started while she was watching television.  She says, "I suddenly started to feel like my heart was racing."  The patient describes mild lightheadedness but no chest pain, shortness of breath, or syncope.  In the past, she has experienced similar episodes of palpitations that were nonsustained and terminated abruptly.  The patient has never sought medical care for these episodes and cannot identify any provoking factor.  She saw a physician for anxiety when she was a teenager but does not remember if she received any therapy.  The patient has no other medical problems and takes no medications.  She does not use tobacco, alcohol, or illicit drugs.  She jogs 2-3 miles a day.  The patient has no family history of coronary artery disease, cardiomyopathy, blood clots, or sudden cardiac death.  She appears mildly uncomfortable but not in any respiratory distress.  Temperature is 36.7 C (98 F) , blood pressure is 100/60 mm Hg, pulse is 172/min, and respirations are 20/min.  Urine pregnancy test is negative.  ECG is shown in the exhibit. The patient receives antiarrhythmic therapy, and her pulse immediately decreases from 172/min to 68/min.  The palpitations resolve, and she states that she feels "normal now."  Cardiac examination reveals no murmurs or additional sounds.  A 12-lead ECG is performed and is shown in the exhibit.  Which of the following is the most likely diagnosis?

• A)Electrolyte disturbance
• B)Ischemic cardiomyopathy
• C)Panic attack precipitating sinus tachycardia
• D)Right bundle branch block
• E)Wolff-Parkinson-White syndrome

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