Acute onset shortness of breath, chest palpitations


• Scene – IV, 12-lead, EKG, O2, NTG, ASA, CBG, vitals

• En route – Vitals, 12-lead, amiodarone 150 mg, IV #2

• Hospital – monitor


• Response to treatment – chest pain went away and SOB got better

• Disposition – Pt states he felt better with the oxygen. He had palpitations with runs of V-TAC, but remained CAO.

• Transported to hospital


Elliot Williams, Paramedic Woodburn Ambulance


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center

• Ventricular tachycardia

Differential Diagnosis

• Ventricular tachycardia

• Myocardial Infarction

• Electrolyte abnormalities: hypokalemia, hypomagnesemia, hypocalcemia

• Recreational drug use (e.g., cocaine)

• Medication overdose (e.g., tricyclic antidepressants

• Congestive heart failure

• Pacemaker failure

Patient Workup History

• Patient states – “I can’t breathe and I need oxygen. If my heart stops, I don’t want anything done to me. I have had a lot of things done and they wanted to put a pacemaker in and I would not let them.”

Physical Exam

• Clammy, SOB

• EKG – SR with PVC and runs of V-TAC

• CBG – 133

• GCS – 15

Editor’s Notes

The monitor demonstrates a run of what appears to be ventricular tachycardia. This patient expressed a desire for minimal intervention; a difficult scenario for the clinical team managing this patient. This patient appears stable and medication therapy is a reasonable first choice. Cardioversion should be considered with unstable patients with this arrhythmia. This is a concerning condition which, if sustained, could lead to cardiac arrest as one potential outcome.

-Dr. David Spiro

Suggested References

Ventricular Tachycardia


• Gender: Male

• Age: 71 years

• Height: Not Available

• Weight: Not Available


• Temperature: Not Available

• Heart Rate: 97-200

• Blood Pressure: 138/89

• Respiratory Rate: 22

• Pulse Oximetry: 97% RA

Signs and Symptoms

Difficulty breathing; palpitations

History Medical


• Allergies: None

• Dispatch info: SOB; Patient took nitroglycerin (NTG) ~ 2 hours ago with a little relief


• Lives at home with family

• Non-smoker


• Lasix, lisinopril, carvedilol, clopidogrel

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