Squiggler

Intermittent palpitations noticed during a night shift

The case

36-year-old woman. Intermittent palpitations noticed during a night shift

No structural heart disease. She drinks several energy drinks during night shifts and takes no regular medication.

On arrival

HR
78
GCS
15
SpO₂ (%)
98
Respiratory rate
16
Temperature (°C)
36.7
Systolic BP (mmHg)
126
Diastolic BP (mmHg)
74

Stage 1 of 1

She is comfortable and the pulse feels irregular in a repeating pattern. The twelve-lead is recorded during the palpitations.

The tracing for the quiz “Intermittent palpitations noticed during a night shift”.
Twelve-lead recorded on arrival, 25 mm/s, 10 mm/mV. Open this tracing in the studio

Observations

HR
78
SpO₂ (%)
98
Respiratory rate
16
Temperature (°C)
36.7
Systolic BP (mmHg)
126
Diastolic BP (mmHg)
74
How should the rhythm regularity be described?
What causes the irregularity on this tracing?
Which feature most strongly argues against atrial fibrillation?

Diagnosis

Sinus rhythm with frequent ventricular ectopy causing a regularly recurrent irregularity

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This tracing was generated, not recorded. It opens in the studio with every dial live.

Open the studio

Discussion

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