u/Internal-Subject352

30 y/o female, Hx of IST/SVT, recent syncope & collape 3x in 6 months. Recently no longer able to tolerate BBs d/t HoTN. Started on Ivabradine 3 days ago. Initially made her very bradycardic in the 30s, halfed the dose and she took it today. 1hr after began feeling very nauseous, dizzy, SOB, mild chest pain. Trops & BNP negative. No other notable labs. Tachy/brady present- 40-122 range- just bouncing back and forth. Heart SOUNDS irregular and sounds like afib on auscultation. I feel like I’m seeing some well defined P-waves & EKG doesn’t look all that irregular or worrisome. She feels ok-ish with activity but feels worse once sitting down and especially when laying down.

Pt does have quite a notable familial cardiac history.