An 80 year old woman presents to your emergency department with palpitations and breathlessness for three days.
She had undergone coronary bypass grafting two weeks earlier.
a. Describe and interpret her ECG (50%) b. List the possible causes of her breathlessness. (50%)
FACEM VAQ Exam 2005.2 – Question 6
- Overall pass rate for this question was 45/56 (80.4%).
- The ECG provided shows a narrow complex tachycardia with electrical alternans.
- Examiners noted that better answers correctly diagnosed the electrical alternans but it was still possible to pass by noting that this was a narrow complex rhythm of which possible causes included a pericardial effusion post surgery
- It was incorrect to call the rhythm atrial fibrillation. It was expected that the list of possible causes for her breathlessness would be structured so as to highlight the important or likely causes in this particular patient.