Mary Sears, MD, Resident in Medicine, Jewish Hospital at Washington University, St Louis: A 22-year-old man came to the emergency room of another hospital complain ing of light-headedness and palpitation of several hours' duration, the onset of which had occurred while he was swimming in a lake. On initial examination his systolic BP was 80 mm Hg and his apical rate was too rapid to count. A 12-lead ECG of poor technical quality showed a grossly irregular rhythm without distinguishable organized atrial activity. The ventricular rate averaged 285 beats per minute, and the width of the QRS complex varied from 80 to 120 ms. Deep Q waves were present in the inferior limb leads, and a tall, primordial R wave was noted in the anterior chest leads V2 and V3. The patient initially received 1 mg of digoxin in two divided doses intravenously (IV), followed by 6 mg
Ruffy R, Sears M, Avioli LV. Wolff-Parkinson-White Syndrome. Arch Intern Med. 1985;145(3):533–536. doi:10.1001/archinte.1985.00360030181031
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