Taken from Medscape

Clinical Case Challenge: In the form of an ECG.

A 27-year-old woman presents to her primary care provider for a routine physical examination. She denies any heart disease and has never had any cardiac symptoms. However, on physical examination, the clinician detects an irregular heart rhythm, and a 12-lead ECG is obtained.

What does her ECG reveal?

Atrial flutter

Atrial fibrillation

Normal sinus rhythm with premature ventricular complexes

Normal sinus rhythm with aberrantly conducted premature atrial complexes (PACs)

Normal sinus rhythm with PACs and Wolff-Parkinson-White (WPW)

Drumroll please....

The diagnosis is normal sinus rhythm, WPW pattern, PACs in bigeminal pattern, and pseudo inferior wall infarction.

Rate: ~66 bpm

Rhythm: Normal Sinus

Axis: Normal Axis

Special: Some P waves have different morphological features (Premature Atrial Contractions). Some QRS complexes have a slurred upstroke (Wolf Parkinson White Syndrome).

Physician described Dilemmas: The 'Undeserving' Patient:

Physicians don't check their humanity at the door. Neither do their patients. For many doctors, that simple truism is the source of frequent conflict and frustration. Says one doctor, frustrated by patients' refusal to quit smoking, watch their diet, or take their medication as directed, simply "remaining engaged in the face of patient apathy" is a daily challenge.

But when patient behavior deteriorates from unhealthy to self-destructive and the medical resources in question are especially precious, the ethical stakes are higher. Physicians responding to the survey describe such situations as "doing a liver transplant on a patient who tried to kill herself" and "offering liver transplant options to alcoholics."

Providing care to people who have committed abhorrent acts has always been and will always be an emotional struggle for doctors. But, as one anesthesiologist notes, the ethics are clear. In administering anesthesia to a prisoner who had thrown acid in the face of a young girl he had raped so that she couldn't identify him, the doctor realized, "The power of life or death is in those syringes. I did the right thing and administered the same safe anesthetic I would to anyone. Only God can be judge and executioner. We are to love our neighbors, even the unlovable ones."