Case 13 – Fast Start

34 – year old masters swimmer at a swim meets puts a hand on his chest and withdraws from his race.

PMHx:
Heart Condition
Medications:
None (Stopped taking a medication for his heart 1 year ago)
Allergies:  Penicillin
PERC – Negative

On Examination:
HR 150, BP 130/90, Temperature 37.1
Speaking full sentences alert
CVS:  S1 S2 no murmur
Resp:  Auscultation clear
MSK: Nil Acute

Question 1)  What is your next step?   __________

EMS is on site and perform a 12 lead:

Question 2)  Diganosis:
A) Supraventricular Tachycardia
B) Wide-complex tachycardia
C) Sinus Tachycardia
D) Brugada Syndrome

Question 3) What treatment can you try pool side?

This treatment option fails and you transfer the athlete to Emergency Department

His Blood pressure is 140/90, heart rate is 150 and his oxygen saturation is 99%

Question 4) What is your next line of treatment?

ANSWERS:
Question 1) Call for help – Activate EAP (Emergency Action Plan)
Question 2)  SVT (supraventricular tachycardia)
Question 3) Valsalva – Ice to face, carotid massage, or modified Valsalva (https://youtu.be/8DIRiOA_OsA)
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Question 4) Adenosine 6mg as a push followed immediately by a normal saline flush  (If that fails, a repeat dose of 12 mg can be given)
This is his cardiac tracing before, during and after treatment:

ECG post treatment:

Dr. Neil Dilworth ( Oct, 2017)