Case 114: A 25 Year-Old Female with Palpitations
History
Diagnosis
ECG 2
ECG 2 Diagnosis
History
A 25 year old female with 5 year history of intermittent palpitations presents to the ER with a one hour history of sustained palpitations. She had previously been seen by a cardiologist and had been found to have a structurally normal heart.
Diagnosis
- Supraventricular tachycardia, 123/min with long RP interval and likely retrograde P-waves (labeled ‘P’)
- Possible paroxysmal junctional reciprocating tachycardia, cannot rule out atypical AV nodal reentrant tachycardia or atrial tachycardia)
ECG 2
The patient was taken to the EP lab and found to have a decrementally conduction accessory pathway in the posteroseptal region of the tricuspid annulus, consistent with a diagnosis of PJRT (paroxysmal junctional reciprocating tachycardia). The ECG below was taken after the procedure.
Comment: The term PJRT is actually a misnomer as this tachycardia is simply a form of AVRT (atrioventricular reentrant tachycardia) with a decrementally conducting accessory pathway which causes the RP interval to be longer than typical AVRT.
ECG 2 Diagnosis
Sinus Rhythm, 71/min
ECG ID: E811