ECG Case: 80-year-old Woman with Palpitations and Shortness of Breath

00:01 So, let's take a look at a case. This is our first case for the 6th lecture.

00:05 Here's an 80-year-old woman, comes to the emergency department complaining of palpitations.

00:11 She feels her heart bouncing around in her chest, she's short of breath, and I'm gonna show you her ECG.

00:17 By the way, this is what I'd like to joke with the residents.

00:20 This scenario is as common as dirt. Why is it so common? Because we're seeing so many people over the age of 80. In the United States, in a 24-hour period today, more people will become aged 85 than will be born and I'll bet it's the same in many European countries. And what are we seeing? A huge increase in the elderly population and this next rhythm is very common in the elderly population.

00:46 So here's a patient with palpitations and dyspnea, comes to the ED and here's the ECG.

00:52 Please take a look at it and come up with a diagnosis yourself.

01:01 So, let me ask you: do you see any abnormal P waves in front of the QRS? I don't.

01:07 Do you see any saw-toothing waves in front of the QRS? I don't.

01:11 Is the QRS normal or very abnormally irregular? I see it as being very abnormally irregular.

01:19 So, the diagnosis is atrial fibrillation and this is pretty fast.

01:24 The heart rates a 150/min, grossly irregular heart rate particularly if you look at the bottom strip.

01:31 It's easy to see with the bottom rhythm strip.

01:33 So, thanks very much for being with us for supraventricular arrhythmias.

01:38 Please stay tuned for ventricular arrhythmias.