darkhorse
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A 20-year-old college student is evaluated for palpitations. She has noticed a rapid pounding in her chest on several occasions. She first noticed it in middle school. Most episodes last less than 1 minute, but a few have lasted one-half hour. During an episode, she feels lightheaded, but is not short of breath and does not have syncope or chest pain. She is most aware of the pounding sensation in her neck. Symptoms usually occur without warning while she is at rest. If she breathes slowly and deeply, the episodes usually stop on their own. They have never interfered with her activities, and she continues to run cross-country. Recently, the episodes have been longer and more frequent. She has never had the rhythm documented. Physical examination and electrocardiogram findings are normal. She has no family history of heart disease.
Which of the following is the most likely diagnosis?
A. Benign premature atrial contractions
B. Palpitations related to mitral valve prolapse
C. Paroxysmal supraventricular tachycardia
D. Ventricular tachycardia
E. Paroxysmal atrial flutter
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| cool doctor
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C
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| amritt786
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C
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| tamerbashir
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c 
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| doyoudig
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C. Paroxysmal supraventricular tachycardia
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| drduck
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can some one tell me what is that pounding sensation reffering to??
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| Vietnamese
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C. She take a deep breath, that mean Valsava manaver work for her to calm down heart rate, so this tachycardiac result from AV node ascendingly, more often AV node (90%) in healthy young.
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| darkhorse
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The correct answer is C
Educational Objectives
Recognize the clinical presentation of paroxysmal supraventricular tachycardia.
Critique
The abrupt onset and regularity of this patients symptoms strongly suggest paroxysmal reentrant supraventricular arrhythmia. Resolution of the episodes may appear gradual because the arrhythmia may convert to sinus tachycardia that gradually slows. The most common type of paroxysmal reentrant supraventricular arrhythmia is atrioventricular nodal reentrant tachycardia, which involves reentry within atrioventricular nodal tissue. The patients awareness of the palpitations as a pounding sensation in the neck is a common finding in supraventricular tachycardia. It likely is related to nearly simultaneous contractions of the atria and ventricles during supraventricular tachycardia, when the ventricular-atrial ratio is 1:1.
Palpitations that are associated with premature ventricular contractions feel like skipped beats or an irregular pulse. Although palpitations are sometimes associated with mitral valve prolapse, this patient has no findings that suggest a structural abnormality. Paroxysmal supraventricular tachycardia is much more common in this age group than is ventricular tachycardia, and atrial flutter is very uncommon in a young, healthy person who has a structurally normal heart. In a young person who has exercise-induced palpitations, a catecholamine-sensitive tachycardia, such as right ventricular outflow tract ventricular tachycardia, must be considered.
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