Electrographical case. Elderly man with acute breathlessness

Sim D, Chia S, Ching CK, Chua T
Correspondence: Dr David Sim, david_sim_kl@nhc.com.sg

ABSTRACT
A 67-year-old Chinese man presented to the emergency department with a history of abdominal bloating and shortness of breath. Initial electrocardiogram (ECG) showed atrial tachycardia (AT) with 2:1 atrioventricular (AV) conduction block. Six days after admission, he developed acute dyspnoea and confusion. Repeat ECG demonstrated a regular wide-complex tachycardia. Serum analysis revealed hyperkalaemia secondary to acute on chronic renal failure. Emergency treatment with intravenous calcium gluconate, 50% dextrose solution and short-acting insulin was instituted. The ECG promptly reverted to a narrow-complex AT with 2:1 AV conduction block. The diagnosis and treatment of AT are discussed.

Keywords: atrial tachycardia, atrio-ventricular conduction block, broad complex tachycardia, tachycardia
Singapore Med J 2007; 48(5): 475–478