A 25-Year-Old Woman Is Evaluated for Occasional Episodes of Palpitations

A 25-year-old woman is evaluated for occasional episodes of palpitations.  She describes the episodes as a sudden, abrupt onset of fast and regular heartbeats that feel like "her heart is racing in her chest."  The episodes are commonly unprovoked and are not related to exertion.  During one episode, her blood pressure was recorded as 100/60 mm Hg and her heart rate was 185/min and regular.  She has no significant past medical history and does not take any medications.  She has no family history of heart disease.  Physical examination is unremarkable, including no heart murmurs or additional sounds.  She also reports that she has been self-treating by immersing her face in cold water during the palpitation episodes.  Generally, she says, cold-water immersion relieves her symptoms abruptly within several minutes.  This maneuver terminates the palpitations by directly altering which of the following?

A) Atrioventricular node conductivity
B) Purkinje fiber conduction
C) Sinoatrial node automatism
D) Vascular tone
E) Venous return to the heart
F) Ventricular myocardium contractility

Correct Answer:

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