Case Study IV

Mr. V. W., a 30 year old triathlon runner, came to the ER complaining of vague chest pain and frequent palpitations after his daily run today. His health history is negative except for a fractured ankle last year after a bike accident. Mr. V. W. denies ever having chest pain in the past.

Physical Assessment:

Neuro: AAOx3, equal strength in all extremities.
Pulmonary: Resp. slightly labored. Lungs clear in all lobes. SpO2: 97%
GI: Normal bowel sounds, complains of some nausea.
GU: Voiding large amounts of clear, pale yellow urine without difficulty.
CV: Pulse irregular, Heart sounds S1 and S2, peripheral pulses strong in all extremities.
Height: 6’0, Weight: 165

History: Mr. V.W. has just recently moved from California to Southern Texas. He remarks about the heat. Mr. V.W. also states that he noticed a weight gain of 10 pounds since his move, which concerns him. He also tells you that he believes his weight gain is due to an increase in "water" and he borrowed a couple of his mother’s "water pills" to try and reduce his weight.
Medications: Multivitamin 1 qd
Herbal energy supplements 2-3xd
Lasix 40 mg x 2 (borrowed from his mother)
Diagnostic studies:

CXR: normal
Labs: Na 131, K+ 3.2 . All other labs within normal limits.
EKG rhythm strip:

Questions:

1. The rhythm Mr. V.W. is experiencing is:
Sinus rhythm with PAC
 2nd degree AV block type II
 Ventricular bigeminy
 Atrial flutter

2. Select all potential causes of the rhythm:

Exercise induced
 Electrolyte imbalance
 Atrial tachycardia
 Bundle block

3. Management for the above rhythm might include:

Cardiac enzyme study
 12-lead ECG
 Beta blocker or calcium channel blocker
 All of the above

4. The premature beats in the rhythm occur:
In the atria
 In the SA node
 In the AV node
 In the ventricles
5. Other causes of the above rhythm (not including Mr. V. W.’s problem) are:
Myocardial ischemia
 Digitalis toxicity
 Increase in circulating catecholamines
 All of the above

The basic dysrhythmia course that is recommended as background for this Cardiac Case Studies course is the RnCeus.com course:

EKG Strip Indentification and Evaluation

*IMPORTANT!

Please write down and save your answers to the above questions. The questions will be repeated on the "Exam and Evaluation", but the scenarios and strips will not be repeated.

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