A 42-year-old woman with a past history of major depressive disorder was seen in clinic for paroxysmal atrial fibrillation (Figure 1). She underwent echocardiography, which showed no significant structural heart disease, and she was prescribed flecainide 100mg/12h. She was subsequently found at home with a reduced level of consciousness. Physical examination revealed hypotension (systolic blood pressure of 80mmHg), and an ECG was performed, which is shown in Figure 2. On arrival at the emergency department, fluid resuscitation and supportive measures were started, and her blood pressure recovered.
What is the most likely diagnosis?
- 1.
Ventricular tachycardia.
- 2.
Supraventricular tachycardia with aberrant conduction.
- 3.
Sinus tachycardia with very aberrant conduction giving the appearance of right bundle branch block, a consequence of massive pulmonary thromboembolism.
- 4.
Flecainide toxicity.
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