A 72-year-old man with a history of chronic obstructive pulmonary disease presents with an increase in shortness of breath that began 2 weeks ago after he experienced an upper respiratory infection presenting with a cough productive of yellowish sputum, pleuritic chest pain, and a low-grade fever with temperatures of up to 100°F. He did not seek medical attention, but because of worsening shortness of breath, he presented to the emergency room. On physical examination, he has bilateral rhonchous sounds and wheezing. A chest x-ray shows evidence of chronic obstructive pulmonary disease with hyperaeration and fibrous streaking. His O2 saturation is 88% on room air. He is placed on supplemental O via a nasal cannula at 4 L/min. He receives albuterol therapy via a nebulizer. Shortly after his first treatment, he is noted to have a transient increase in heart rate, and an ECG is obtained.
What is the diagnosis?
To submit your diagnosis, go to http://circ.ahajournals.org/letters/submit/circulationaha;129/11/1262. The diagnosis will follow in next week’s issue (March 25).
Please go to the journal’s Facebook page for more ECG Challenges: http://goo.gl/cm4K7. Challenges are posted on Tuesdays and Responses on Wednesdays.
- © 2014 American Heart Association, Inc.