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Sixty eight‐year‐old male with ischemic cardiomyopathy has this EKG finding
Author(s) -
Shah Priyank,
Koomson Edward
Publication year - 2018
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1002/joa3.12076
Subject(s) - medicine , sinus tachycardia , cardiology , palpitations , anesthesia , heart failure , tachycardia , ejection fraction
A 68-year-old-male with past medical history of ischemic cardiomyopathy (ejection fraction 35%-40%), hyperlipidemia, and chronic obstructive pulmonary disease presented to the hospital with worsening dyspnea on exertion and orthopnea for 4-5 days. He denied any chest pain, palpitations, leg swelling, dizziness, syncope, fever, chills, nausea, or vomiting. Vital signs on presentation were as follows: temperature—98.9 F, blood pressure—132/84 mm Hg, pulse —121 beats per minute, and respiratory rate—19 per minute. Oxygen saturation was 94% on room air. Cardiopulmonary examination revealed tachycardia, regular S1, S2, presence of S3, jugular venous distension, and bilateral inspiratory crackles. Initial electrocardiogram (EKG) in emergency department showed sinus tachycardia at 115 beats per minute with nonspecific intraventricular conduction delay without any ischemic changes. Chest x-ray showed pulmonary congestion. His TSH was normal (2.82 IU/mL). Patient was admitted for heart failure exacerbation and started on intravenous loop diuretic. He was not on beta-blocker at home, and hence, beta-blocker was not started on admission. Myocardial infarction was ruled out. By day 3 of hospitalization, he diuresed well and his breathing improved. He was switched to oral loop diuretic, and carvedilol 12.5 mg twice a day was initiated. The EKG performed later that day is shown in Figure 1. What would be the next best step in the management of this patient?

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