We present the case of a 70-year-old woman with hypertension and a history of paroxysmal episodes of palpitations for which she occasionally took bisoprolol. She suddenly had an episode of palpitations of greater severity and duration than previous ones, which were accompanied by dizziness and precordial oppression. The patient took 5mg of bisoprolol and attended the emergency room. On arrival, she no longer had any cardiac symptoms and was hemodynamically stable. Chest X-ray and blood work were normal. Her electrocardiogram is shown in Figure 1.
What is the most appropriate approach to the immediate diagnostic process in this patient?
- 1.
Electrocardiographic monitoring for 12hours in the emergency room
- 2.
Carotid sinus massage
- 3.
Electrophysiological study
- 4.
24-hour outpatient Holter study
Submit your answer to http://www.revespcardiol.org/en/electroreto/72/06. The solution will be published in the next issue (July 2019). #ECGChallenge #RetoECG.