ER case of persistent Papitations

F.B. 40 year old female, came in due to palpitations. Known asthmatic since childhood, on PRN ventolin inhaler and tablets. no nocturnal attacks. One week PTC, patient had on and off palpitations relieved spontaneously. 3 days PTC, palpitations recurred and persistent, accompanied by difficulty of breathing. She then started using ventolin nebulization 4-5x a day. PE: BP 120/80 HR 108 RR 23 O2SAT 98% pink palpebral conjunctivae, anicteric sclerae supple neck, no CLAD, (+) palpable soft movable anterior neck mass moves with deglutition approximately 2x3cm. symmetrical chest expansion, no retractions, wheezes on both lung fields, no crackles adynamic precordium, AB at 5th LICS MCL, no murmurs f labby abdomen, soft, non-tender no edema, no cyanosis at the ER patient was immediately hooked to cardiac monitor: Questions: 1. What is your working impression? 2. Any differentials? differential 1 differential 2 rule in rule out diagnostics 3. What will be your management? include the labs you will request and your treatment.

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AF with FVR DD 1) Hyperthyroidism ,with AF 2) Bronchial asthma, COPD, PAH , AF 3) B agonist induced palpitations Suggest ECHO , Thyroid profile, Electrolytes, Xray chest

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Strip shows ventricular tachycardia Pt is kco of asthma and on inhalers Adv AbG and r/o respiratory alkalosis Sos metabolic acidosis and anion gap

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ECG is showing irregularly irregular rhythm associated with fast ventricular rate Adv 12 lead ECG 2 D Echo Amiodarone / Beta blocker to reduce fast ventricular rate

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Check Arterial Blood Gas to review Acidosis. HBA1C / S.Elecrolyte./ Thyroid profile.

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AF with FVR Adv: ABG Serum electrolytes TSH HBA1C

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Sinus Tachycardia RBBB

Go for thyroid &Echocardiogram

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