Atrial flutter (AF) is the second most common supraventricular tachyarrhythmia following atrial fibrillation. 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). A 72-year-old African-American female with history of PD presented to our Emergency Department with a one day history of chest pain. Her vital signs were within normal limits. Physical exam was remarkable for bilateral resting hand tremors at a frequency of 6-8 hertz and mild cogwheel rigidity in both upper extremities. Initial ECG was interpreted as AF prompting admission. 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. A repeat 12 lead ECG clearly demonstrated normal sinus rhythm, and the patient remained completely asymptomatic throughout the stay. 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. Correct and accurate diagnosis is critically important, in order to avoid wrong treatment and unnecessary interventions. Our case illustrates the importance of recognizing artifact related ECG changes to prevent unnecessary treatment and hospital admissions.
This study was done because there is an absence of data and research related to the Dynavision. The Dynavision is a light board that trains and records reaction time and trains central and peripheral vision. Concussion Vital Signs is an online neurocognitive test that measures Visual Memory, Visual Memory, Psychomotor Speed, and Reaction time. OBJECTIVE The purpose of this study was to determine if training on the Dynavision three days a week for six weeks has an effect on Concussion Vital Signs performance. DESIGN Randomized Control Trial (RTC) SETTING Athletic Training Laboratory PARTICIPANTS College-aged students picked from a convenience sample of athletic training students n = 22 (males: 10 females: 12) (Age: mean = 22.45 sd: ±3.33). INTERVENTION Six weeks of training sessions on the Dynavision. MAIN OUTCOME MEASURES Change in Concussion Vital Signs scores RESULTS Dynavision training had a positive correlation on CVS reaction time scores. Paired t-test results CVS Reaction time (.001), CVS Shifting attention Correct reaction time (.090). Pearson r for all four reaction time tests were positive and showed an increase. CONCLUSIONS Dynavision training did improve reaction time scores on Concussion Vital Signs. The training did not affect any other test batteries on CVS. Some more research needs to be put into CVS.
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