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Challenges in Clinical Electrocardiography
November 12, 2018

A Wide Complex Tachycardia in a Woman During ExerciseDid She Tread Into Dangerous Territory?

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2Division of Cardiology, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California
JAMA Intern Med. Published online November 12, 2018. doi:10.1001/jamainternmed.2018.6207

A 65-year-old woman with type 2 diabetes, hypertension, dyslipidemia, and obesity presented to her primary care clinician with 2 months of worsening dyspnea on exertion. Her medications included lisinopril, aspirin, and atorvastatin. Her vital signs were within normal limits, and her cardiac and respiratory examinations were unremarkable. Routine laboratory evaluation revealed an elevated blood glucose level; her basic metabolic panel, thyroid-stimulating hormone, and B-type natriuretic peptide levels were all within normal limits. A 12-lead electrocardiogram (ECG) demonstrated normal sinus rhythm with narrow QRS complexes. Given the patient’s symptoms of dyspnea on exertion, an exercise treadmill test (ETT) was performed to evaluate for coronary artery disease (CAD) (Figure).

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    1 Comment for this article
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    jean pierre usdin, MD | Cabinet d'Esperey Paris Fra
    Thank you for this well documented and interesting paper.
    However, due to this patient's risk factors and symptoms related to exercice did she undergo CT scan Coronary angiogram? (or coronary artery angiography?)