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Fifty-year-old woman with lightheadedness
  1. Pishoy Gouda1,
  2. George Veenhuyzen2,
  3. Bryan Har2
  1. 1 Division of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
  2. 2 Division of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Pishoy Gouda, PGY-1 Internal Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada; pishoy.gouda1{at}


Clinical introduction A 50-year-old woman presented to the emergency department with a 3-year history of worsening episodes of lightheadedness, anxiety and diaphoresis. She was otherwise healthy. Her cardiovascular physical examination was normal apart from an irregularly irregular pulse of 105 beats per minute. When she arrived in the emergency department, a 12-lead ECG was obtained (figure 1).

Question What is the most likely diagnosis?

  1. Atrial fibrillation (AF)

  2. Atrial premature beats

  3. Atrioventricular (AV) reciprocating tachycardia

  4. Dual AV nodal non-reentrant tachycardia (DAVNNT)

  5. AV nodal re-entrant tachycardia


  • ECG/electrocardiogram
  • Cardiac arrhythmias
  • resuscitation science

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  • Competing interests None declared.

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