She denied any family history of heart disease. No other cardiovascular risk factors of significance were present. She denied shortness of breath, dyspnea, orthopnea, palpitations, or syncope. Our patient was a 72-year-old African-American female with history of PD who presented to our Emergency Department with a one day history of chest pain which was described as midsternal tightness relieved by taking oral antacids. In this case report, we present an interesting case of a diagnostic challenge manifested as an ECG recording mimicking AF in a patient with PD and discuss existing literature. Parkinsonian tremors are one of the common causes of electrocardiographic artifacts resembling AF ( 2, 5- 11). The typical resting tremor of PD is present at rest with a frequency of 4–6 hertz, which is similar to that of AF i.e., 250–350/min, and also overlaps that of ventricular tachycardia i.e., 120–250/min. This can save unnecessary aggressive interventions, like administration of anticoagulation, that are not inconsequential. Hence while making a diagnosis of tachyarrhythmia, one must always consider the possibility of an artifact. The risk of subsequent cerebral embolization with lone AF is as high as with lone atrial fibrillation, therefore appropriate electrocardiographic diagnosis is of utmost importance for guiding subsequent management plan ( 3, 4).Īrtifacts are a common finding in patients requiring an electrocardiogram (ECG) in the in-patient setting. Patients usually present with symptoms of dyspnea, palpitations, fatigue, and dizziness. It is characterized by an atrial rate of approximately 300 beats/minute and a regular ventricular rate of about 150 beats/minute. Atrial flutter (AF) is an uncommon arrhythmia encountered in clinical settings, which requires careful evaluation. The predominant non motor symptoms are olfactory dysfunction, autonomic dysfunction, psychiatric symptoms, sleep disorders, cognitive impairment, pain and fatigue ( 1). The motor symptoms include bradykinesia, muscular rigidity, postural and gait impairment, and rest tremor. It affects approximately 1–2% of people 65 years and older ( 2). Parkinson’s disease (PD) is a common neurological disorder with depletion of dopaminergic neurons in the substantia nigra pars compacta ( 1). Keywords: Pseudo flutter Parkinson’s electrocardiogram (ECG) atrial flutter (AF) Our case illustrates the importance of recognizing artifact related ECG changes to prevent unnecessary treatment and hospital admissions. Correct and accurate diagnosis is critically important, in order to avoid wrong treatment and unnecessary interventions. A 48-hour Holter monitoring in the clinic later confirmed consistent sinus rhythm with no evidence of any arrhythmias Tremor induced artifacts can be mistaken for arrhythmias. A repeat 12 lead ECG clearly demonstrated normal sinus rhythm, and the patient remained completely asymptomatic throughout the stay. After careful review of her ECG by a cardiologist, several features such as, sharply contoured upright p waves in all leads, different flutter wave morphologies in the same leads, more prominence of “pseudo-flutter” waves in the limb leads compared to the precordial leads, and return to isoelectric baseline after sharp peaked p waves, questioned the diagnosis of AF. Initial ECG was interpreted as AF prompting admission.

Physical exam was remarkable for bilateral resting hand tremors at a frequency of 6–8 hertz and mild cogwheel rigidity in both upper extremities. Her vital signs were within normal limits. A 72-year-old African-American female with history of PD presented to our Emergency Department with a one day history of chest pain. We present an interesting case of a diagnostic challenge manifested as an electrocardiogram (ECG) recording mimicking AF in a patient with Parkinson’s disease (PD). Policy of Dealing with Allegations of Research MisconductĪbstract: Atrial flutter (AF) is the second most common supraventricular tachyarrhythmia following atrial fibrillation.

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Atrial flutter vs sinus tachycardia