Electrocardiographical case. Elderly man with acute breathlessness. Atrial tachycardia with variable AV conduction block and transient hyperkalaemia-induced aberrant conduction.
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.
Sim
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Department of Cardiology, National Heart Centre, Mistri Wing, Singapore. david_sim_kl@nhc.com.sg
Chia
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Ching
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CK
Chua
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D000368:Aged; D002037:Bundle-Branch Block / Q000150:complications / Q000175:diagnosis*; D004417:Dyspnea / Q000209:etiology*; D004562:Electrocardiography; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D006947:Hyperkalemia / Q000150:complications*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism; D008297:Male; D013610:Tachycardia / Q000150:complications* / Q000503:physiopathology