Case 1:
A 28 y-old man presented to our hospital with history of palpitation from 8 years ago. He described his palpitation as episodic events that occurred 1 or 2 times per year, but from 4 month ago it was more frequent (about one per month). The palpitation lasted about 1 minute and worsen with stress. He reported having numerous stressful events in the recent that made the episode of palpitation more frequent for him.
He denied angina, syncope attack or any other associated symptoms. He denied any symptoms suggestive of orthopnea, paroxysmal nocturnal dyspnea, weight gain, or pedal edema.
He had been using cigarette (2 packs/year). He was not on any prescription, over-the-counter medications, supplements, or herbal remedies.
The patient denied any family history of sudden cardiac death, cardiac arrhythmias or CAD.
On examination, he was stable and in no distress. Her blood pressure was 115/76 mmHg with a regular pulse of 76 beats per minute. he had no clinical evidence of heart failure on cardiovascular examination.
An electrocardiogram (EKG) was ordered for evaluation of palpitation;
ECG revealed a regular, wide QRS sinus rhythm with delta wave; this suggested that the patient had an atrioventricular reentrant tachycardia (AVRT) through an accessory pathway (AP).
The polarity of the delta waves was positive in lateral and all precordial leads with an R/S > 1 in V1, and negative polarity in inferior leads which suggested a left- posterior sided AP (Fig-2).