Tremors Mimicking Atrial Flutter in an Elderly Lady

We present an interesting case where electrocardiogram (ECG) recording in a patient with tremors mimics atrial flutter. A 77 -year-old south Asian lady with history of hypertension and Parkinson‘s disease presented to a tertiary care hospital in Pakistan with cough and fever. On second day of admission she started having pleuritic chest pain, Initial ECG was interpreted as atrial flutter. When her ECG was reviewed by a cardiologist, several features questioned the diagnosis of atrial flutter. A repeat 12 lead ECG clearly demonstrated normal sinus rhythm and the patient remained completely asymptomatic throughout the hospital stay. Tremor induced artifacts can be mistaken for arrhythmias. Correct diagnosis is critically important, in order to avoid wrong treatment and unnecessary interventions.