A primigravid patient in their 20s during the eighth month of gestation presented with history of regular nonexertional episodic palpitations that lasted for a few minutes and subsided spontaneously over the past several days. The patient had no associated sweating, syncope, dyspnoea, orthopnoea, or paroxysmal nocturnal dyspnoea. Visible neck pulsation was noticed by the patient’s mother. The patient had no chronic medical comorbid conditions and was not taking any medications. At presentation, blood pressure was 110/70 mm Hg and heart rate was 120 beats/min. The general examination was unremarkable. The jugular venous pulsations revealed regular cannon waves, and auscultation was significant for a variable first heart sound. Examination findings of other systems were normal. Results of blood investigations (complete blood cell count; kidney, liver, and thyroid function; serum electrolytes; and cardiac troponin) were within normal limits. The patient had good biventricular function and normally functioning valves on 2-dimensional transthoracic echocardiography. An electrocardiogram (ECG) taken at the time of admission is depicted in Figure, A.
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Corresponding Author: Kapil Rajendran, MD, DM, Department of Cardiology, Government TD Medical College, Kailas Indeevarm, Punnapra, Alappuzha, PIN−688004, Kerala, India (email@example.com).
Published Online: May 30, 2023. doi:10.1001/jamainternmed.2023.0692
Conflict of Interest Disclosures: None reported.
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