Lets discuss
Youngdoctor - 07-14-09 02:28 Bookmark and Share

An ECG was given. It was of very poor quality. There were no p-waves in any
of the lead and history was somewhat like this… Old lady presents with
palpitation. What is the first step in your management






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#1
Re: Lets discuss
Youngdoctor - 07-14-09 02:33

My answer is: b.

#2
Re: Lets discuss
conym5 - 07-14-09 09:13

It looks like atrial fibrilllation in a patient with palpitation means may be patient is unstable
so I would go for Cardioversion
Pacemaker in case of bradycardia in unstable patient.

#3
Re: Lets discuss
bingousmle - 07-14-09 10:27

My answer is: e.


absence of p waves makes atrial fibrillation a likely possibilty.. but if it is of undependable quality then it also makes it unreliable... plus we also need to take the hemodynamic status of the female into account ...

#4
Re: Lets discuss
drbasim - 07-14-09 16:18

My answer is: a.

#5
Re: Lets discuss
ysemak - 07-14-09 17:55

My answer is: b.

#6
Re: Lets discuss
conym5 - 07-14-09 19:20

what is the answer youngdoctor?

#7
Re: Lets discuss
InSitu - 07-14-09 22:15

My answer is: e.

#8
Re: Lets discuss
InSitu - 07-14-09 22:16

you got us youngdoc

#9
Re: Lets discuss
omojesu - 07-15-09 03:16

My answer is: e.

#10
Re: Lets discuss
adipocito - 07-18-09 07:38

My answer is: e.

#11
Re: Lets discuss
zoah2005 - 07-18-09 09:30

My answer is: b.

#12
Re: Lets discuss
ramya123 - 07-19-09 02:17

My answer is: c.

#13
Re: Lets discuss
84ahsan - 07-19-09 10:32

My answer is: c.

#14
Re: Lets discuss
drsadia - 07-23-09 09:31

My answer is: b.

#15
Re: Lets discuss
usmlefever3 - 07-24-09 08:54

My answer is: b.

#16
Re: Lets discuss
drfuture - 07-24-09 17:36

My answer is: b.

#17
Re: Lets discuss
bahaeldin77 - 07-25-09 04:48

My answer is: e.

#18
Re: Lets discuss
hardas13 - 08-03-09 12:51

My answer is: d.

#19
Re: Lets discuss
neetzmathai123 - 08-05-09 06:55

My answer is: b.

#20
Re: Lets discuss
sweety - 08-10-09 18:50

My answer is: b.

#21
Re: Lets discuss
conym5 - 08-10-09 19:44

My answer is: b.

#22
Re: Lets discuss
paleti1987 - 08-11-09 09:19

My answer is: d.

#23
Re: Lets discuss
gurmeetsand - 08-13-09 08:39

My answer is: a.

#24
Re: Lets discuss
soyyodotcom - 08-13-09 11:28

My answer is: c.

#25
Re: Lets discuss
doczuzu - 08-14-09 16:49

My answer is: b.

#26
Re: Lets discuss
drusmleworld - 08-19-09 07:38

My answer is: c.

#27
Re: Lets discuss
burova - 08-21-09 19:30

My answer is: b.

#28
Re: Lets discuss
docraj - 08-21-09 22:00

My answer is: b.

#29
Re: Lets discuss
docraj - 08-21-09 22:02

better to first do TEE to rule out mural thrombosis.

#30
Re: Lets discuss
surendra - 08-22-09 04:45

My answer is: b.

#31
Re: Lets discuss
mtniharika - 09-10-09 14:04

My answer is: c.

#32
Re: Lets discuss
tvaqar - 09-14-09 17:16

My answer is: e.

#33
Re: Lets discuss
tvaqar - 09-14-09 17:17

The question stem says nothing about her hemodynamic status so I assumed that she is hemodynamically stable.

#34
Re: Lets discuss
tvaqar - 09-14-09 17:27

Assuming that it is A-fib:

New onset Afib -> Hemodynamically stable -> yes -> control rate (<100 / min) using diltiazem, verapamil, or beta blocker or digoxin if in heart failure


New onset Afib -> Hemodynamically unstable -> cardioversion (sedate before) until sinus rhythm returns -> consider anticoag after patient is stable

Ans: Digoxin seems like the closest bet but it doesnt say whether she is in heart failure or not.

#35
Re: Lets discuss
saurabhsingh - 09-16-09 13:54

My answer is: b.

#36
Re: Lets discuss
lakreol - 09-16-09 21:06

My answer is: b.

#37
Re: Lets discuss
reksarma - 09-24-09 08:15

My answer is: d.

#38
Re: Lets discuss
japes09 - 09-24-09 08:57

My answer is: d.

#39
Re: Lets discuss
afinaish - 09-25-09 10:40

My answer is: e.

#40
Re: Lets discuss
amaniagz - 10-02-09 07:48

My answer is: c.

#41
Re: Lets discuss
vernette - 11-08-09 07:54

My answer is: d.

#42
Re: Lets discuss
dadukids - 12-07-09 02:50

My answer is: a.

#43
Re: Lets discuss
hadeelaya - 12-14-09 23:25

My answer is: e.

#44
Re: Lets discuss
tianjin - 12-15-09 03:27

My answer is: b.

#45
Re: Lets discuss
badrh4sse5n - 12-15-09 06:36

My answer is: d.

#46
Re: Lets discuss
medusmle01 - 12-16-09 01:19

My answer is: c.

#47
Re: Lets discuss
demolition - 12-23-09 21:33

My answer is: b.

#48
Re: Lets discuss
drmead - 12-26-09 13:33

My answer is: e.

#49
Re: Lets discuss
nidayasir - 12-26-09 13:37

My answer is: e.

#50
Re: Lets discuss
nidayasir - 12-26-09 13:42

i guess no any other symptom told ,fr just palpitations 1st line s reassurance n beta blocker like proprano;o; fr 1 week in small doses n follow up.....

#51
Re: Lets discuss
rababzain - 12-28-09 14:19

My answer is: d.

#52
Re: Lets discuss
medic - 12-29-09 05:16

My answer is: c.

#53
Re: Lets discuss
aaronhurowitz - 01-01-10 16:43

My answer is: e.

#54
Re: Lets discuss
dream77boy - 01-02-10 05:13

My answer is: a.

#55
Re: Lets discuss
dinmenace - 01-03-10 15:32

My answer is: b.

#56
Re: Lets discuss
virenbjmc - 01-05-10 03:43

My answer is: b.

#57
Re: Lets discuss
oldman - 01-11-10 06:15

My answer is: a.

#58
Re: Lets discuss
manny1964 - 02-07-10 10:39

My answer is: e.

#59
Re: Lets discuss
leminesow - 02-07-10 11:24

My answer is: a.

#60
Re: Lets discuss
tahiraraees - 02-07-10 13:43

My answer is: d.

#61
Re: Lets discuss
shahra - 02-17-10 01:48

My answer is: c.

#62
Re: Lets discuss
drhumaira - 02-17-10 09:13

My answer is: d.

#63
Re: Lets discuss
dana44 - 02-19-10 18:27

My answer is: d.

#64
Re: Lets discuss
komalz - 02-19-10 20:46

My answer is: d.

#65
Re: Lets discuss
hind708 - 03-04-10 07:58

My answer is: c.

#66
Re: Lets discuss
gill2010 - 03-05-10 11:54

My answer is: e.

#67
Re: Lets discuss
syedhussain - 03-05-10 12:00

My answer is: a.

#68
Re: Lets discuss
dreguieg - 03-06-10 21:51

My answer is: a.

#69
Re: Lets discuss
pawan238 - 03-09-10 01:30

My answer is: c.

#70
Re: Lets discuss
vaishali - 03-09-10 09:10

My answer is: b.

#71
Re: Lets discuss
navid1352 - 03-10-10 02:02

My answer is: e.

#72
Re: Lets discuss
ammulufy - 03-12-10 20:30

My answer is: b.


No P waves indicate d patient's heart is under d control of ventricles alone landing up in VT n den VF....

#73
Re: Lets discuss
residencyrace - 05-30-10 10:16

My answer is: d.

#74
Re: Lets discuss
bolajipoland98 - 06-01-10 01:42

My answer is: d.

#75
Re: Lets discuss
usmlerose - 06-01-10 10:32

My answer is: c.

#76
Re: Lets discuss
samyou - 06-02-10 15:59

My answer is: a.

#77
Re: Lets discuss
enas3110 - 06-04-10 16:04

My answer is: d.

#78
Re: Lets discuss
saadraees - 06-07-10 06:38

My answer is: c.

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