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Challenges in Clinical Electrocardiography | ONLINE FIRST

Dual Ventricular Rhythm—Quiz Case ONLINE FIRST

Apurva O. Badheka, MD; Peeyush M. Grover, MD; Tanyanan Tanawuttiwat, MD; Amit Badiye, MD; George R. Marzouka, MD; Nileshkumar J. Patel, MD; Sandra V. Chaparro, MD; Raul D. Mitrani, MD
JAMA Intern Med. Published online June 03, 2013. doi:10.1001/jamainternmed.2013.7043a
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A 74-year-old man with a history of heart transplant presented with altered mental status. On admission, his blood pressure was 96/63 mm Hg and his heart rate was 72/min. On examination, he was in no immediate distress and had clear lung fields. There were no gallops on examination, and he had no focal neurological deficits. A median sternotomy scar and a left upper chest medical device were noted. The patient was unable to provide any history. His relatives confirmed prior heart transplant.

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Figure 1. The 12-lead electrocardiogram obtained at the time of initial evaluation.

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