We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Challenges in Clinical Electrocardiography |

Factitious Ventricular Tachyarrhythmia Outbreak

Pinter Arnold, MD; Sklar Lawrence, MD; Dorian Paul, MD, MSc, FHRS
Arch Intern Med. 2011;171(3):191. doi:10.1001/archinternmed.2010.537.
Text Size: A A A
Published online


July 22-23, 2009: A 23-year-old male patient with a history of syncope was seen at a small community hospital. The patient described an unwitnessed episode of syncope that occurred at rest. The onset of syncope was sudden, and the recovery was prompt. It was unclear how long he was unconscious. He had no injury. The patient had a history of hypertension and hyperlipidemia, a family history of premature coronary artery disease, and asthma from childhood. He was taking amlodipine, 5 mg/d, and atorvastatin, 40 mg/d. Findings from physical examination were unremarkable. The electrocardiogram showed no abnormality. The patient was admitted to the telemetry unit for monitoring. At 11:43 PM on the night of admission, the telemetry alarm went off indicating “ventricular tachycardia (VT) 235 bpm [beats per minute],” lasting for approximately 15 seconds (Figure 1). The episode was not witnessed, but the patient reported loss of consciousness. Ventricular tachycardia was diagnosed by the attending physician, and the patient was started on therapy with amiodarone and metoprolol. The standard 12-lead electrocardiogram (ECG) showed no abnormality suggestive of cardiac ischemia, and troponin levels were not elevated. The patient complained of chest pain and requested narcotic analgesics. When the narcotic analgesics were denied, the patient discharged himself from the hospital.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Figure 1.

Telemetry recoding on July 22, 2009, at 11:43 PM. Channel 1: electrocardiogram (ECG) (lead II, 1 mV/10 mm, 25 mm/s speed). Channel 2: ECG (lead V1, 1 mV/10 mm, 25 mm/s speed). Asterisks indicate the true QRS signals marching through the artifact. Arrows indicate nonphysiological short coupling intervals.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
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.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

1 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles