1. This patient has Wolff-Parkinson-White Syndrome (WPW). The etiology of her arrhythmia can be mapped to the slowed, slurred upstroke on the R-wave. This slow depolarization, also known as preexcitation, is manifested on ECG as a delta wave, and is pathognomonic of a bypass-tract mediated reentry tachycardia.
2. Acute Management options
unstable -> synchronized DC cardioversion
stable -> anti-arrhythmics (prolongation of accessory pathway: sotalol, amiodarone, flecanide, procanamide)
drugs that shorten refractory period are contraindicated (digoxin)
avoid drugs that increase ventricular rate (verapamil and lidocaine)
avoid drugs that have no effect on refractory period of accessory pathway (beta-blockers)
Long-term Management -> radio-frequency ablation
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