A 73-Year-Old Man with a 2-Week History of Palpitations

Case
The patient is a 73-year-old male smoker who complains that he has had intermittent palpitations for the past 2 weeks. He denies chest pain, diaphoresis, fever, or dizziness. He uses home oxygen, 2 L/min, but denies any new shortness of breath.

Upon exam, you find:
General: Alert and oriented x 3
Lungs: Scattered minimal wheezing, which is symmetric
Cardiovascular: Regular and tachycardic without murmur, rub, or gallop
Abdomen: Soft and nontender without rigidity, rebound, or guarding
Extremities: No pain or swelling, pulses are 2+ and equal in all four extremities

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