Saturday, July 8, 2017

Wolf Parkinson White

A 47 year old patient with new onset of chest pain and shortness of breath. Hx of HTN.  EKG show a rapid atrial fibrillation.  Initial treatment with Diltiazem 10 mg IV x 2, then started on a drip which was titrated up to 10 mg/hr without any change in the rate. The patient was then given Amiodarone 150 mg IV over 10 minutes x 2. The rate and rhythm remained unchanged. The patient was then given Metoprolol 5 mg IV.  This caused a drop in the blood pressure. The patient remained in a rapid atrial fibrillation.  The patient was then cardioverted at 100 J and converted to a junctional rhythm. Follow up EKG show WPW.  TNIs: negative. Electrolytes: WNL,  UDS: + cocaine. (Patient denied any drug hx).


After cardioversion
Follow up EKG



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