76-Year-Old Man With Palpitations

A 76-year-old male physician with a history of hypertension and hypercholesterolemia presented to the emergency department (ED) with palpitations and diaphoresis that began while watching the first 2016 presidential debate. He measured his pulse at 150 beats/min and self-administered 2 doses of propranolol 10 mg during a 3-and-a-half-hour period, without improvement. On arrival to the ED, his pulse rate had slowed to 120 beats/min, as shown in Figure 1. The initial troponin I level was 0.04 ng/mL.

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