Case study I

Mr. G. is a 30-year-old male. He has a history of paroxysmal atrial dysrhythmias and has been placed on quinidine for rhythm control. He has not had an episode in about 6 months and is considered to be stable on this medication.

Mr. G. is independent, lives alone, and holds a high-level position with a local software company. Recently, he came to the ED with complaints of shortness of breath, dizziness, and intermittent "palpitations"

Physical Assessment

Neuro: AAO x 3, follows commands, moves all extremities equally. Complains of intermittent dizziness.

Pulmonary: Respirations rapid, lungs clear in all lobes.

GI: Normal bowel sounds. Complaints of nausea.

GU: Normal

CV: Pulse rapid and irregular, nailbeds pink, peripheral pulses present, but weak. Complains of intermittent chest pain and palpitations.

Vitals: HR-150 and irregular, Respiratory rate 28, BP 102/56, Temp. 98 F, SpO2 96

History Mr. G states that he is just recovering from a serious flu episode. He has experienced diarrhea and vomiting for several days.
He began feeling better and resumed his medications and went back to work. >Medications Quinidine 400 mg, 3xday Vitamins ASA 80mg/day Diagnostic studies CXR: Normal Labs: Na 135, K 3.2, BUN 27, Creat. 1.4, Blood sugar 100mg/dl EKG rhythm strip:

Questions: (IMPORTANT! See instructions below*)

1. Identify the dysrhythmia.
Atrial fibrillation
 PSVT
 Torsade de Pointes
 3rd Degree Heart Block
2. What could have caused the above dysrhythmia?
Food poisoning
 Hypokalemia
 Hypercalcemia
 Stopping his quinidine
3. What are the treatments for this dysrhythmia?
IV KCl to correct deficiency
 IV lidocaine to stop the dysrhythmia
 CPR
 IV procainamide
4. What is the mechanism that starts this dysrhythmia?
Prolonged PR internal
 Shortened QRS
 Prolonged QT
 Elevated ST segment

5. What is the prognosis for Mr. G?

Good, after correction of electrolyte imbalance and successful synchronized cardioversion
 Poor, this is a lethal dysrhythmia
 Good, after he has an ablative procedure
 Poor, his flu weakened him too much to recover


The basic dysrhythmia course that is recommended as background for this Cardiac Case Studies 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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