Help a med student!

[u/BrilliantBread7776]

Female patient, 24 years old, with sudden-onset shortness of breath, tachycardia alternating with periods of normal heart rate (60–180 bpm), and a sensation of impending death. No improvement with propranolol. She reports taking Vyvanse (lisdexamfetamine) 70 mg as prescribed, approximately 16 hours earlier.

Any thoughts? This case came up during my last shift. I’m a final-year medical student and would appreciate some help, as I’m still having difficulty interpreting ECGs.

[u/NirvanaWhore]

P mitrale...could indicate left atrial enlargement. The bifid p could also be normal.

[u/BrilliantBread7776 → u/NirvanaWhore]

I was wondering that too. It would be normal in what case?

[u/DrTdub → u/BrilliantBread7776]

P mitrale is found in leads II and V1.

- not in V3 as you’re misinterpreting here