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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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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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