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Cardiology

Pseudotachycardia in a Teenager With Recurrent Syncope

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JAMA Internal Medicine

Published Online: February 27, 2023

Challenges in Clinical Electrocardiography

Article Information and Disclosures

Jinzhu Hu, MD, PhD¹;

Kui Hong, MD, PhD¹;

Gan-Xin Yan, MD, PhD^2,3

Author Affiliations

¹Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
²Fuwai Huazhong Hospital, Zhengzhou, Henan, China
³Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania

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A teenager with a history of cardiomyopathy and recurrent syncope was admitted to the pediatric unit with a urinary tract infection. Levofloxacin was started along with outpatient medications of metoprolol and valsartan. The patient had symptomatic improvement of the urinary tract infection and was ready for discharge on day 3 after hospital admission. However, the patient lost consciousness suddenly and had seizurelike activities with urine incontinence. The patient regained consciousness with a blood pressure of 86/45 mm Hg and pulse oximetry of 95% on oxygen via nasal cannula after brief cardiopulmonary resuscitation. A 12-lead electrocardiogram (ECG) was urgently obtained and is shown in the Figure. A bedside 2-dimensional echocardiography revealed biatrial enlargement, left ventricular hypertrophy with ejection fraction of 47%, and no pericardial effusion.

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A teenager with a history of cardiomyopathy and recurrent syncope was admitted to the pediatric unit with a urinary tract infection. Levofloxacin was started along with outpatient medications of metoprolol and valsartan. The patient had symptomatic improvement of the urinary tract infection and was ready for discharge on day 3 after hospital admission. However, the patient lost consciousness suddenly and had seizurelike activities with urine incontinence. The patient regained consciousness with a blood pressure of 86/45 mm Hg and pulse oximetry of 95% on oxygen via nasal cannula after brief cardiopulmonary resuscitation. A 12-lead electrocardiogram (ECG) was urgently obtained and is shown in the Figure. A bedside 2-dimensional echocardiography revealed biatrial enlargement, left ventricular hypertrophy with ejection fraction of 47%, and no pericardial effusion.

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Article Information

Corresponding Authors: Kui Hong, MD, PhD, Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China (hongkui88@163.com); Gan-Xin Yan, MD, PhD, Lankenau Medical Center, Main Line Health, 100 E Lancaster Ave, Wynnewood, PA 19096 (yang@mlhs.org).

Published Online: February 27, 2023. doi:10.1001/jamainternmed.2022.6455

Conflict of Interest Disclosures: Prof Yan reported grants from the Sharpe-Strumia Research Foundation outside the submitted work. No other disclosures were reported.

References

Lee RJ , Liem LB , Cohen TJ , Franz MR . Relation between repolarization and refractoriness in the human ventricle: cycle length dependence and effect of procainamide. J Am Coll Cardiol. 1992;19(3):614-618. doi:10.1016/S0735-1097(10)80281-5 PubMed Google Scholar Crossref

Algeo SS , Ewy GA . Pseudo-atrial rhythm due to electrical ventricular separation. Am Heart J. 1985;109(4):900-902. doi:10.1016/0002-8703(85)90656-8 PubMed Google Scholar Crossref

Sirinvaravong N , Heimann M , Liskov S , Yan GX . Dual atrial rhythms: a case report of an unusual cause of pacemaker syndrome. Eur Heart J Case Rep. 2022;6(1):ytab531. doi:10.1093/ehjcr/ytab531 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.