How do you manage a patient with palpitations as fast as 250 bpm?

Rapid progression to fulminant ARDS

A teenager with type 1 diabetes presents with rapidly progressive respiratory failure. Requiring BiPAP, then intubation SIMV-PS, APRV, then oscillator. There’s no history of drug use, huffing, no new medications, or industrial or environmental exposures. He has a one-week history of prodrome diarrhea, cough, fevers, and hyperglycemia. An infection work-up has been negative (HIV, PJP, BAL and blood cultures, viral PCR, CMV, fungal cultures and PCR). No eosinophils on BAL. No improvement with pulse steroids, antibiotics, antivirals, or antifungals. What do you think is the cause? See the case here.

What next steps would you take?

A young patient presents with recurrent palpitations which have been as fast as 250 beats per minute. What is the underlying condition that predisposes them to this rhythm? Find out here.


These cases were originally published in the August 15, 2019 edition of The Differential for Circulation newsletter. The Differential is our premium newsletter which rounds up the most interesting and useful clinical cases based on your specialty. To sign up for this email in any of its 10 specialty-specific editions, download the Figure 1 app and update your email preferences.