A 62-Year-Old Woman with Dizziness and Palpitations

Case
The patient is a 62-year-old woman who presents to the urgent care center after 1 hour of intermittent dizziness and feeling of palpitations. She has no chest pain, fever, vomiting, or diarrhea. Further history reveals that she has a history of anxiety, which is manifested by intermittent feeling of heart “palpitations.”

Her primary care doctor is treating her with a selective serotonin reuptake inhibitor (SSRI) for anxiety.
Upon exam, you find:

• General: Alert and oriented; mildly tachypneic
• Lungs: CTAB
• Cardiovascular: Regular and tachycardic without murmur, rub, or gallop
• Abdomen: Soft and nontender without rigidity, rebound, or guarding
• Extremities: No pain or swelling of the lower extremities; pulses are 2+ and equal in all 4 extremities

View the ECG and consider what the diagnoses and next steps would be. Resolution of the case is described on the next page.