An individual in their early 70s presented to the emergency department with dizziness and weakness in bilateral lower limbs for 7 days. The patient had a 7-year history of hypertension; a 10-year history of diabetes; and denied tobacco, alcohol, or illicit drug use. The patient had bradykinesia, left-hand tremor, and postural instability. At admission, blood pressure and pulse rate were 149/76 mm Hg and 92 beats per minute, respectively. Laboratory results (hemogram, serum electrolytes, kidney and hepatic function tests, and D-dimer levels) were all within normal limits. An electrocardiogram (ECG) was obtained on admission (Figure, A). On initial evaluation, the emergency department resident suspected that the patient had ventricular tachycardia (VT). However, the patient did not have palpitations or hemodynamic instability; heart sounds and pulse rate were normal; and pulse oxygen saturation waveform showed that the ventricular activity had a normal rate. The senior clinician suggested holding the patient’s tremulous left upper extremity while obtaining a repeat ECG (Figure, B).
Zhai H, Zheng B, Zhai G. Is a Shaking Hand or a Trembling Heart Producing Changes in Electrocardiogram Findings? JAMA Intern Med. 2022;182(7):772–773. doi:10.1001/jamainternmed.2022.1796
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