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Challenges in Clinical Electrocardiography
April 2016

An Elderly Patient With Palpitation and a Negative Nuclear Stress Test Result

Author Affiliations
  • 1Section of Cardiology, School of Medicine, University of Tennessee, Memphis, Tennessee
  • 2Veterans Affairs Medical Center, Memphis, Tennessee
  • 3School of Medicine, Virginia Commonwealth University, Richmond
JAMA Intern Med. 2016;176(4):542-544. doi:10.1001/jamainternmed.2016.0023

A man in his 80s was hospitalized with recurrent syncope. He denied chest pain. On admission, he was hemodynamically stable and physical examination had normal results. Electrocardiography (ECG) showed sinus rhythm, right bundle branch block, and T-wave inversion in inferior and V3 through V6 leads (Figure 1). His serial troponin levels were negative for abnormalities. Because of baseline abnormal ECG results and low ejection fraction, he underwent regadenoson vasodilator stress myocardial perfusion imaging (MPI) to rule out ischemic cardiomyopathy. There was no ischemia and no left ventricle cavity dilation during stress imaging. However, just before discharge, he developed palpitations with mild chest discomfort. The patient’s ECG during palpitation is shown in Figure 2. He was symptomatic with normal blood pressure, so he was treated with an intravenous β-blocker. Following that, his symptoms resolved (Figure 3).

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