Challenges in Clinical Electrocardiography |

Sustained Ventricular Fibrillation in a Conscious Patient

Thomas A. Dewland, MD; John S. Chorba, MD; Nora Goldschlager, MD; Gregory M. Marcus, MD, MAS
Arch Intern Med. 2011;171(11):973. doi:10.1001/archinternmed.2011.235.
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A 44-year-old man with a nonischemic dilated cardiomyopathy treated with an implanted left ventricular assist device (LVAD) was admitted to our hospital for diuresis after presenting with acute decompensated heart failure. His admission blood pressure was 95/65 mm Hg. Serial troponin measurements were negative. While hospitalized, the patient developed a wide complex tachycardia on telemetry monitoring resulting in multiple successive discharges from his implantable cardioverter-defibrillator (ICD). On evaluation, the patient was conversant and without complaint of lightheadedness or palpitations. Bilateral radial and femoral pulses were absent. An automated cuff was unable to measure a brachial blood pressure in either arm. An electrocardiogram (ECG) was obtained (Figure 1).

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Figure 1.

Ventricular fibrillation. There are no regularly spaced R waves or rhythmic deformations in the tracing to suggest artifact.

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