This is middle-aged male who presented to ED with palpitation...average Taiwan aborigine.
I first saw him during my 1 years of practice, I was in charged of the emergency department then. Below is his EKG...
My spot diagnosis was PSVT then- usual antiarrythymia drug was given and he was discharged later. He had multiple episode of attack and most of the doctors in our hospital saw him. Sometimes - procainame works, sometimes verapamil work, however his symptom was settled most of the times in the ED. Until one day, he was seen and managed by our cardiologist and he was diagnosed as WPW syndrome. I smacked my head when I saw the cardiologist's note written at the front page of his case note - I missed it...A little embarass for a graduate from my college - during the our school days, there was this topic special on this WPW syndrom, an old professor who was very specialised in it. Well, so the verapamil was off from the antiarrythymic arsenal for him. I recalled there was 1 time when I had tried every drug I had ( minus adenosine - it was still a rare drug then). So I took my risk of giving him a dose of verapamil and successfully reverted him to sinus. But some of the doctors still refuse to do so and few times he was referred to a bigger hospital and got admitted.
For the past 10 years, he had seen in our hospital for 200+ times. The cardiologist had suggested him to go for EPS and ablation but he refuse. To make things worst - he had bad veins. There was a few times when I need to insert a int jugular line for him.
Today he came again...now he had developed atrial fibrillation - he had presented with the same old symptom - palpitation. However the EKG shows atrial fibrillation with short run VT...I load him with 300mg of amiodarone parenterally and his rhythm was reverted to sinus after 20min...he was discharged again.
This patient had saved me during my viva of the internal medicine examination. The examiner displayed an ECG through the projector and I did spot diagnosis - WPW.
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