Racing Heart

1. Racing Heart

You are called emergent to a 36-year-old female who feels weak. About 30 minutes ago, while trying to sleep, she felt her heart “racing.” She now complains of chest pain vs. palpitations. Patient denies other medical history or allergies, and only takes birth control. Skin is pink, warm, dry.

She is stable. Vitals: BP 122/80, HR 160, RR 22, SpO₂ 99% RA. Initial EKG shows SVT. IV and 12-lead started, unremarkable aside from rate.

Vagal maneuvers unsuccessful.

Adenosine 6 mg given, no effect. Patient reports chest discomfort but recovers quickly.

After adenosine, patient shows transient bradycardia on monitor.

Patient briefly converted but then slumps, unresponsive, HR 180 bpm.

If tachycardia recurs after adenosine and cardioversion, but patient remains stable: