Author/Authors :
Köprülü, Diyar Ordu State Hospital - Clinic of Cardiology, Turkey , Zengin, Halit Ondokuz Mayıs University - Faculty of Medicine - Department of Cardiology, Turkey , Acar, Zeydin Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital - Clinic of Cardiology, Turkey , Demircan, Sabri Ondokuz Mayıs University - Faculty of Medicine - Department of Cardiology, Turkey
Abstract :
A 60-year-old woman with rheumatoid arthritis (RA) presents to the emergency room with palpitation and near syncope. Her hemodynamic was unstable and electrocardiogram (ECG) showed a wide QRS tachycardia. A sinus rhythm was obtained after electrical cardioversion (DC). The patient s history revealed infrequent palpitation with presyncope symptoms. She was on methotrexate and cyclosporine. She had no family history of sudden death and similar disease. On physical examination, her blood pressure after DC was 130/80 mmHg, pulse rate was 80/min. Upper extremity examination revealed radial deviation of both wrist with ulnar deviation of the finger (‘’Z’’ deformation) and swan-neck deformities of the fingers of both hands (Fig. 1). After DC, control ECG showed right bundle branch block with epsilon wave in V1 and ST segment depression in precordial leads (V2-V4) (Fig. 2).
