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Broad complex tachycardia: a diagnostic dilemma
  1. V Adhiyamana,
  2. S Froesea,
  3. A Vaishnavia,
  4. R Cowellb
  1. aWithybush General Hospital, Haverfordwest, Dyfed SA61 2PZ, UK, bWrexham Maelor Hospital, Wrexham, Clwyd LL13 7TD, UK
  1. Dr Adhiyaman, Department of Geriatric Medicine, Glan Clwyd Hospital, Rhyl, Denbighshire LL18 5UJ, UKadhiv{at}btinternet.com

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Answers on p 803.

A 56 year old woman was admitted to hospital with an hour long history of palpitations. She had suffered palpitations on three occasions over the preceding 12 months, each lasting for approximately half an hour. During these episodes she felt light headed but had not lost consciousness. Past medical history was unremarkable and she was taking no drugs.

On admission to hospital her symptoms had settled spontaneously and clinical examination was normal. A 12 lead ECG showed sinus rhythm and no other abnormality. Baseline blood tests, cardiac enzymes, and thyroidfunction tests were normal. She remained in sinus rhythm over the subsequent 24 hours and Holter monitoring was arranged as an outpatient. However, just before her discharge her symptoms returned and the heart rate was 160 beats/min and blood pressure 90/70. A 12 lead ECG was recorded which is shown in fig 1.

Figure 1

ECG record during tachycardia.

Questions

(1)
What is the diagnosis?
(2)
What is the most important differential diagnosis?
(3)
How would you treat this condition?

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