ECG Challenge: Weak and Faint

Figure. ECG tracing

HISTORY: A 50-year-old female with a history of hypertension and diabetes mellitus is brought to the ED by ambulance for sudden onset of palpitations and near-syncope. She denies any chest pain, shortness of breath, or history of heart disease. Her symptoms are ongoing at the time of your evaluation. She denies ever having felt like this before

EXAM: On exam she is in moderate distress stating she feels like she is going to pass out. Her pulse is rapid and weak at 210 beats/min and her blood pressure is 75/35 mmHg. Her lungs are clear and there is no peripheral edema. The rest of her exam including an oral temperature and pulse ox reading are unremarkable.

TESTS: A tracing that shows three leads from her ECG is shown in the Figure above (please click to enlarge). Results of labs and chest x-ray are pending.

Initial Concern(s): supraventricular tachycardia (SVT), ventricular tachycardia (v-tach), Wolff-Parkinson-White (WPW) syndrome.

Questions

1. Is this SVT, V-tach, WPW or something else?

2. How should you treat this patient?

Please click here for answers and discussion.