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Challenges in Clinical Electrocardiography
Dec 12 2011

The Irregular Tachycardia That Was Not Atrial Fibrillation

Author Affiliations
 

SECTION EDITORS: JEFFREY TABAS, MD; PAUL D. VAROSY, MD; GREGORY M. MARCUS, MD; NORA GOLDSCHLAGER, MD

Arch Intern Med. 2011;171(22):1985. doi:10.1001/archinternmed.2011.577

A 49-year-old woman was admitted to the inpatient cardiology service with complaints of palpitations, fatigue, and dyspnea on exertion. During a previous hospitalization she was noted to have a paroxysmal, irregular tachycardia with largely the same left bundle branch block that was seen during normal sinus rhythm; this arrhythmia was believed by her physicians to represent atrial fibrillation. At that time, findings from echocardiography were consistent with rheumatic mitral valve disease. Her outpatient medical regimen consisted of metoprolol tartrate and warfarin sodium for presumed valvular atrial fibrillation. An electrocardiogram (ECG) was obtained at the time of readmission (Figure 1).

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