Approach to tachycardia Quiz: Ace Your Exams

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A 72-year-old man comes to the emergency department for evaluation of palpitations and shortness of breath. The symptoms started early in the morning and have been intermittent throughout the day. Past medical history is significant for chronic obstructive pulmonary disease, chronic hypoxemic respiratory failure for which he is on 4 liters of oxygen via nasal cannula, and pulmonary hypertension. Medications include albuterol, fluticasone, salmeterol, and umeclidinium. Temperature is 36.8 ºC (98.2 ºF), pulse is 120/min and irregular, blood pressure is 132/81 mmHg, respiratory rate is 18/min and SpO2 is 88% of 4 liters of oxygen via nasal cannula. Electrocardiogram is obtained and is shown below. Which of the following is the most likely diagnosis?
 
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