Course: Unusual Electrocardiogram Findings After Cardioversion
CME Credits: 1.00
Released: 2022-12-05
An individual in their late 60s presented with a 4-day history of palpitations at rest and reported 2 months of exertional breathlessness. The patient’s medical history was notable for metastatic bladder carcinoma followed by palliative chemotherapy and pulmonary tuberculosis treated with antituberculous therapy for 6 months 10 years earlier. On physical examination, the patient had a pulse rate of 84 beats per minute (bpm) and blood pressure of 112/76 mm Hg. Jugular venous pressure was notable for a prominent y descent. Cardiovascular examination was otherwise unremarkable. Results of a transthoracic echocardiography showed biatrial dilatation, normal biventricular systolic function, grade III diastolic dysfunction, and significant transmitral flow variations—features suggestive of constrictive pericarditis. Findings of an electrocardiogram (ECG) at presentation were consistent with typical atrial flutter with an atrioventricular Wenckebach conduction. After ruling out atrial thrombi, the patient underwent synchronized electrical cardioversion. Results of ECGs performed before and after cardioversion are shown in the .
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