Abstract

A 49-year-old white man was admitted to the emergency department with nausea and diarrhea of 11 hours duration. He had experienced crampy abdominal pain as well. He reported that his stools had been dark and malodorous. He had no prior history of gastrointestinal disorders, nor travel, unusual oral or liquid intake. There was a remote history of alcohol abuse, but no hepatitis or cirrhosis. Recent alcohol intake was denied by the patient. He had no medical allergies. His past medical history was pertinent for a history of hypertension, congestive heart failure, and a dual chamber pacemaker insertion. There was no history of diabetes mellitus, smoking, or myocardial infarction. Medications included lisinopril, a small dose of aspirin daily, and thyroid supplement. Family history was negative for cardiomyopathy, sudden cardiac death, gastric or duodenal ulcers, colon cancer, or any congenital abnormalities.

Highlights

  • A 49-year-old white man was admitted to the emergency department with nausea and diarrhea of 11 hours duration

  • His past medical history was pertinent for a history of hypertension, congestive heart failure, and a dual chamber pacemaker insertion

  • History was negative for cardiomyopathy, sudden cardiac death, gastric or duodenal ulcers, colon cancer, or any congenital abnormalities. [West J Emerg Med. 2011;12(4):565–566.]

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Summary

Introduction

Twelve-lead electrocardiogram shows sinus tachycardia with evident 2:1 block of paced beats followed by 1:1 atrioventricular synchronous pacing at 118 beats per minute. EXPLANATION Postventricular atrial refractory period (PVARP) plus atrioventricular (AV) interval equals or limits the upper rate limit. The patient has a physiologic sinus tachycardia, but the pacemaker is not programmed for rates this high.

Results
Conclusion
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