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A 42-year-old woman with a history of anxiety presents, complaining of intermittent palpitations over the past 2 weeks. She says she has not taken any medication and denies chest pain, shortness of breath, diaphoresis, fever, or dizziness.

Upon exam, you find:

  • General: Alert and oriented X 3
  • Lungs: Clear to auscultation bilaterally
  • Cardiovascular: Regular and tachycardic without murmur, rub, or gallop
  • Abdomen: Soft and nontender without rigidity, rebound, or guarding
  • Extremities: No pain or swelling, pulses are 2+ and equal in all 4 extremities

View the ECG and consider what the diagnoses and next steps would be. Resolution of the case is described on the next page. 

Clinical Challenge 2: October 2017