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Challenges in Clinical Electrocardiography |

New-Onset Heart Failure in a Patient With a Pacemaker An Unusual Cause

Matthew William Paul Jackson, MBChB1; Robin James Taylor, MBChB, MRCP1
[+] Author Affiliations
1James Cook University Hospital, Middlesbrough, England
JAMA Intern Med. 2016;176(1):110-111. doi:10.1001/jamainternmed.2015.6543.
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An elderly woman presented with gross peripheral edema extending to the abdominal wall 2 months after a tissue aortic valve replacement for severe symptomatic aortic stenosis. Her immediate postoperative recovery had been complicated by developing atrial fibrillation associated with an uncontrolled ventricular rate, which was treated with bisoprolol and amiodarone, achieving cardioversion to sinus rhythm on discharge.

Echocardiography demonstrated normal biventricular function with a well-seated, normally functioning aortic valve replacement and moderately severe mitral and tricuspid regurgitation. Preoperatively, she had only mild mitral regurgitation and tricuspid regurgitation. On examination, she had a regular pulse of 60 beats/min and her blood pressure was 120/80 mm Hg. Cannon waves were visible in the jugular venous pressure waveform.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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