A 54-year-old woman is brought to the emergency department for palpitations. In triage she has a heart rate of 120 bpm, BP 143/89, SpO2 99%. Shortly after being roomed, she begins to complain of worsening symptoms and looks pale. Repeat vitals are obtained, and she is placed on the monitor.

Repeat blood pressure is 100/88, the monitor reads a heart rate of 236.

An ECG is obtained and shows rapid atrial flutter with 1:1 conduction.

While establishing the safety net (IV x2, placing the defibrillation pads on her, and bringing the crash cart to the bedside) her heart rate spontaneously slows.

She looks less pale, and repeat blood pressure is 137/95.

You look at the monitor and now see Atrial Fibrillation with a ventricular rate in the 140s.

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