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Challenges in Clinical Electrocardiography
May 23, 2022

Is a Shaking Hand or a Trembling Heart Producing Changes in Electrocardiogram Findings?

Author Affiliations
  • 1Department of Geriatrics, The People’s Hospital of Bozhou, Bozhou Clinical College Affiliated with Anhui Medical University, Bozhou City, Anhui Province, China
  • 2Department of Emergency, Fu Zhou Changle District Hospital, Fuzhou, Fujian, China
  • 3Emergency Department, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
JAMA Intern Med. 2022;182(7):772-773. doi:10.1001/jamainternmed.2022.1796

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).

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