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Young man with life-threatening palpitations
  1. Rahul Kumar,
  2. Dinkar Bhasin,
  3. Anunay Gupta
  1. Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
  1. Correspondence to Dr. Anunay Gupta, Assistant Professor of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110092, India; dranunaygupta{at}

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Clinical introduction

A young man in his 30s presented to the emergency department with palpitations. There was history of similar episodes of palpitations which terminated spontaneously. There was no history of syncope with these episodes. At presentation, his heart rate was 230 beats per minute and the blood pressure was 110/70 mm Hg. He did not have angina, dyspnoea or dizziness. The ECG at presentation is shown in figure 1.

Figure 1

Twelve-lead ECG at presentation.


1. Which of the following drugs will be best suited for treating this patient?

  1. Intravenous amiodarone

  2. Intravenous metoprolol

  3. Intravenous ibutilide

  4. Intravenous adenosine

Answer: C

The ECG shows an irregular wide complex tachycardia (WCT) with varying QRS wave morphology and the shortest RR …

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  • RK and DB are joint first authors.

  • Twitter @anunay_cardio

  • RK and DB contributed equally.

  • Contributors RK and DB contributed equally to the manuscript and are joint first authors. All authors contributed to design, data collection, draft preparation and manuscript review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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