UMMC Cases Part IV: Two Easily Missed ECG Diagnoses

UMEM Potpourri ECG Cases with Dr. Amal Mattu

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HPI

A 73-year-old woman presents to the ED with palpitations and shortness of breath. Her ECG shows a regular narrow-complex tachycardia, and the computer interpretation is accepted by both the emergency physician and cardiologist. But something important has been missed.

Before watching this week’s workout, review the ECG carefully and consider:

1. 1. What is your differential diagnosis for a regular narrow-complex tachycardia?
   2. What subtle atrial activity might be hiding within what initially appears to be a straightforward rhythm?
   3. If the diagnosis remains uncertain, what simple bedside techniques can help expose the underlying atrial rhythm?