22-year-old healthy male who notes a history of palpitations as a child, presents with heart palpitations, described as irregular and rapid heartbeat for the past 2 months. Patient states he became sick with what he thought was the stomach flu about 6 days ago with nausea and vomiting, no diarrhea. He arrives anxious, in moderate distress, with the rhythm above. CBC showed WBC count of 18.7 with left shift, otherwise unremarkable. Chemistry panel as above. Tox screen negative. INR was 1.5. Patient was given 12mg of adenosine with a decreased heart rate into the 160s. Cardioversion was considered, but the duration of his symptoms have been too long. Cardiac echo will be obtained. Thoughts?

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ECG shows atrial fibrillation ( varying RR with absent p) xray shows heart shadow mimicking egg on stalk appearance...there is ra dilation blood picture shows evidence of sepsis with shock To rule out corrected tga , septic shock n AF with rapid ventricular rate

A.fib with RVR X-RAY show cardiomegaly Do Echo Possibility of valvular heart disease r very high Don't use Adenosine

AF WITH FVR need and acute hepatitis. Adenosine has no role, a deltiazem can be given regular basis and echocardiography to plan. Udca and antibiotic coverage.

Cardiomegaly.

Cardiomegaly with straightening Lt heart boarder Need 2D Echo to further evaluation

Ap x ray so can't guess about cardiomegaly Svt Needs Echo Cardiac mr

Cardiomegaly with possibly pericardial effusion.. Echo must..underlying valvular heart disease may be the etiology

Should recieve oseltamavir

Straightening of left heart border

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