Adolscent AF

[Kiwiology]

Had an interesting job come my way

18 yom cc feeling unwell/dizzy/spaced out/tired all day for no apparent reason

Fast AF at about 180 no pmhx/family hx etc etc

I have never seen very fast AF esp in a young healthy person with no history of cardiac problems or stimulants like it came down in the last shower

Anybody?

[DwayneEMTP]

Had an interesting job come my way

18 yom cc feeling unwell/dizzy/spaced out/tired all day for no apparent reason

Fast AF at about 180 no pmhx/family hx etc etc

I have never seen very fast AF esp in a young healthy person with no history of cardiac problems or stimulants like it came down in the last shower

Anybody?

Yeah, and I was surprised too, though I'm guessing others may have seen it more often.

18 y/o black male being supported by his mom, tons of drama, had bs written all over it. I had just transfered care of my patient and the ER was pretty busy so I snatched him up and took him into triage to get a set of vitals and start a history for them. As soon as he said, 'Afib' I thought, "yeah, must have heard that from your mom." I grabbed a pulse and it was really fast, irregular, it felt like Afib with RVR?? No sign of stimulants, kid looked like a jock...I felt like a bigger ass than usual.

Called the doc in and it turned out he'd been seen for it several times before. They converted it chemically and he went about his way... (reported, I'd long ago left at that point.)

In all the hearts in all the world I guess we shouldn't so much be surprised that this would present sometimes in someone so young, but perhaps that it doesn't do so more often.

Dwayne

[Kiwiology]

Guess it didn't just come down in the last shower then; this one didn't break with amiodarone and wasn't sick enough for ALS to cardiovert.

Knowing my luck I'd have zapped him only to have it come up at audit "dude, you were trying to cardiovert artifact!"

[fiznat]

I've actually caught a few of these lately. College kids with symptomatic tachycardias between 180-220 (some of them fib or flutter). I think it is less common to see this condition in such a young population, but not necessarily unusual. Cardizem works great...

[Kiwiology]

Exactly what this guy was, must be something in the water

[usmc_chris]

Hello all,

I've been around for a while, reading posts, but haven't really posted (too busy with Paramedic class, will be done in a couple months!!) This post caught my eye, I thought, I might actually know what that is!

Have you considered alcohol as a cause, especially in the college-age population? I wouldn't be so sure about this cause in the 18 yo with the hx of recurrent afib, but it is very common to see paroxysmal supraventricular tachydysrhythmias in otherwise healthy patients a day or so following the consumption of a large amount of alcohol. This most commonly presents as atrial fibrillation with RVR, but sometimes can be seen as a traditional SVT such as AVNRT. This would be common in the college-age binge drinking population, and and a rash of these patients are often seen in the ED following major holidays - thus the condition is termed holiday heart syndrome. These patients usually spontaneously convert back to a sinus rhythm with no treatment, however in symptomatic patient I certainly wouldn't withhold treatment.

Chris

[DwayneEMTP]

Hello all,

I've been around for a while, reading posts, but haven't really posted (too busy with Paramedic class, will be done in a couple months!!) This post caught my eye, I thought, I might actually know what that is!

Have you considered alcohol as a cause, especially in the college-age population? I wouldn't be so sure about this cause in the 18 yo with the hx of recurrent afib, but it is very common to see paroxysmal supraventricular tachydysrhythmias in otherwise healthy patients a day or so following the consumption of a large amount of alcohol. This most commonly presents as atrial fibrillation with RVR, but sometimes can be seen as a traditional SVT such as AVNRT. This would be common in the college-age binge drinking population, and and a rash of these patients are often seen in the ED following major holidays - thus the condition is termed holiday heart syndrome. These patients usually spontaneously convert back to a sinus rhythm with no treatment, however in symptomatic patient I certainly wouldn't withhold treatment.

Chris

Awesome first few posts man! Welcome (still) to the City!

Have you heard what the likely pathophysiology of this effect is? I can't see it secondary to simple dehydration unless it's due to the electrolyte shift perhaps...Not sure.

Any ideas?

Dwayne

[Eydawn]

Dwayne- general emedicine article on the pathophys of "holiday heart": http://emedicine.medscape.com/article/155050-overview

Didn't have a chance to read it in detail, but it talks about the arrhythmogenic properties of alcohol and why...

Wendy

CO EMT-B