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Emergency Medicine

A Pregnant Patient With Narrow QRS Tachycardia

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JAMA Internal Medicine

Published Online: May 30, 2023

Challenges in Clinical Electrocardiography

Article Information and Disclosures

Kapil Rajendran, MD, DM¹;

Vinayakumar Desabandhu, MD, DM¹;

Pranay Ghanshyam Jambhulkar, MD, DM¹

Author Affiliations

¹Department of Cardiology, Government TD Medical College, Alappuzha, Kerala, India

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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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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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Article Information

Corresponding Author: Kapil Rajendran, MD, DM, Department of Cardiology, Government TD Medical College, Kailas Indeevarm, Punnapra, Alappuzha, PIN−688004, Kerala, India (kapilmddm87@gmail.com).

Published Online: May 30, 2023. doi:10.1001/jamainternmed.2023.0692

Conflict of Interest Disclosures: None reported.

References

Surawicz B , Knilans TK . Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric. Elsevier Saunders; 2008.

Rosen KM . Junctional tachycardia: mechanisms, diagnosis, differential diagnosis, and management. Circulation. 1973;47(3):654-664. doi:10.1161/01.CIR.47.3.654 PubMed Google Scholar Crossref

Libby P , Bonow RO , Mann DL , et al. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. Elsevier; 2022.

Tamirisa KP , Elkayam U , Briller JE , et al. Arrhythmias in pregnancy. JACC Clin Electrophysiol. 2022;8(1):120-135. doi:10.1016/j.jacep.2021.10.004 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 [and Self-Assessment requirements] 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.