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A 39 year old female complains of a sudden episode of palpitations lasting 5 minutes which has now resolved. She denies chest pain and denies any past medical history. She denies using any medications or street drugs. She has normal vital signs in the emergency department. She is not pregnant. What does the EKG show ? Rate: 70 Rhythm: sinus Axis: normal PR: 0.04 QRS: 0.12, delta waves ST: no elevations, inverted T in III, aVF EKG diagnosis: Sinus rhythm with delta waves Clinical diagnosis: Wolff-Parkinson-White syndrome (WPW) If this patient had a pulse of 220, what is your treatment? Do NOT use beta blockers, calcium channel blockers, or digoxin as these will block the AV node and lead to 100% conduction through the accessory pathway and lead to increased tachycardia. You may use Amiodarone, procainamide or if hemodynamically unstable, synchronized cardioversion.
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