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Image challenge
Palpitations in a 46-year-old man
  1. Vineet Kumar1,
  2. Momen Eltelbany2,
  3. William Fonbah1
  1. 1Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
  2. 2Faculty of Medicine, Ain Shams University, Cairo, Egypt
  1. Correspondence to Dr Vineet Kumar, Division of Cardiovascular Diseases, University of Alabama at Birmingham, FOT 930D, 1720 2nd Avenue South, Birmingham, AL 35294, USA; vkumar{at}uab.edu

https://doi.org/10.1136/heartjnl-2015-307771

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    Clinical introduction

    A 46-year-old man with no significant medical history was seen for palpitations. A Holter monitor was placed and following recording was obtained (figure 1).

    Question

    What is the most likely diagnosis?

    1. Atrioventricular (AV) nodal reentrant tachycardia with aberrancy

    2. Antidromic and orthodromic tachycardia

    3. Orthodromic reentrant tachycardia with aberrancy

    4. Ventricular tachycardia

    Figure 1

    Holter monitor with lead I and V6 showing wide complex tachycardia at a rate of 188 beats/min (bpm; tachycardia cycle length 320 ms) which transitions to a narrower complex tachycardia at a faster rate of 222 bpm (tachycardia cycle length 270 ms).

    For the answer see page 1601

    From the question on page 1561

    Answer: C

    Orthodromic reentrant tachycardia with aberrancy using a left side accessory pathway.

    Holter …

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    Footnotes

    • Contributors VK: Manuscript preparation and initial diagnosis; ME: manuscript preparation; and WF: image contribution.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.