Rate and rhythm
13 cases filed under rate and rhythm. Each opens on a tracing, asks what is on it, and ends with the reading worked through.
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Three months of the heartbeat stumbling, with an occasional sensation that it stops
No cardiac history. Drinks four coffees a day. No syncope, no chest pain, no breathlessness. The pulse is irregular at rest. Examination is otherwise normal. Potassium, magnesium…
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Palpitations on and off for three weeks, now persistent for two hours with mild breathlessness
Non-smoker, no cardiac history. Takes no regular medication. She has lost three kilograms over six weeks without trying and reports feeling hot and restless. No syncope, no chest…
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A thumping in the chest when he lies down at night, going on for months
Fit, plays football twice a week and has never had symptoms while running. No blackouts. No family history of sudden death. Takes nothing; drinks little coffee. He is well, with a…
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Collapsed at the kitchen sink with no warning, out for a few seconds
Paroxysmal atrial fibrillation on apixaban. Treated hypertension. Bisoprolol increased from 2.5 mg to 5 mg three weeks ago for palpitations. Two similar collapses in the past…
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Intermittent palpitations noticed during a night shift
No structural heart disease. She drinks several energy drinks during night shifts and takes no regular medication. She is comfortable and the pulse feels irregular in a repeating…
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Found drowsy at home with an empty packet of her own tablets
Amitriptyline for post-herpetic neuralgia and ramipril for hypertension. Lives alone, no cardiac history, no previous overdose. Bronwen Ellis was found by her daughter at midday…
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Blackout in a supermarket queue, with no warning
Hypertension on bisoprolol for years. Donepezil started six weeks ago for early Alzheimer's disease. Two episodes of feeling faint in the last month; this time he went to the…
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Palpitations that started suddenly during a lesson
Primary school teacher, well, no medication apart from the contraceptive pill. Two similar episodes in the past two years, both stopping on their own within twenty minutes. Two…
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Palpitations for three weeks, worse over the last two days
No cardiac history and no regular medication. Six kilograms of unintended weight loss since the spring, heat intolerance and a fine tremor. Referred by her GP as fast atrial…
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Monitor alarm on the coronary care unit
Day one after primary PCI to the left anterior descending artery for an anterior infarct. On aspirin, ticagrelor, bisoprolol and atorvastatin. Pain free since the procedure…
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Two days of vomiting, poor appetite and confusion
Permanent atrial fibrillation on digoxin 125 micrograms daily, bisoprolol and apixaban. Chronic kidney disease with a baseline creatinine of 110 umol/L. Started clarithromycin…
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Sudden palpitations and light-headedness on the assessment unit
Anterior myocardial infarction six years ago, treated with primary PCI to the LAD. Takes bisoprolol, ramipril, atorvastatin and aspirin. Admitted this morning with two weeks of…
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Collapse in the waiting room, three days into a diarrhoeal illness
Takes citalopram 40 mg daily for depression. Three days of vomiting and diarrhoea after a family barbecue, eating and drinking almost nothing. Given ondansetron 4 mg intravenously…
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