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Finally, do a coronaryangiogram Possible alternative to pacing is to give a beta-1 agonist to increase heart rate. Because she has cardiomyopathy and ventricular dysrhythmias, the pacer included an Implanted Cardioverter-Defibrillator (ICD) Echo 6 days later after CRT: Normal estimated left ventricular ejection fraction.
Workup including routine laboratory results, 12-lead electrocardiogram (ECG), echocardiogram, and coronaryangiogram was non-specific. During the intravenous lacosamide infusion, the patient developed sudden cardiac arrest caused by ventricular arrhythmias necessitating resuscitation. 2893C>T, p.Arg965Cys) in the SCN5A gene.
The routine laboratory results, imaging study, coronaryangiogram, and echocardiogram (ECG) were normal. For secondary prevention, the patient underwent implantable cardioverter defibrillator implantation. The patient did not have underlying diseases. A type 1 BrS pattern was identified in one resting ECG.
During angiogram in the cath lab, the patient suffered two episodes of ventricular fibrillation for which he was successfully defibrillated. Angiogram showed a culprit lesion of 100% stenosis to the right coronary artery and 100% stenosis of the right posterior descending artery, both with TIMI 0 flow.
We can, therefore, put down the defibrillation pads, set aside the amiodarone, and look further at the ECG. Indeed, bedside Echocardiogram revealed severe left ventricular impairment of Takotsubo cardiomyopathy. The coronaryangiogram revealed no critical stenosis, or acute plaque ulceration.
CT coronaryangiogram showed a hypoplastic RCA and dominant LCx. Most patients can be managed without and implantable cardioverter defibrillator (ICD) In patients with PVCs/VT and a presentation not typical for an idiopathic origin cardiac magnetic resonance (CMR) should be considered, even if the Echo is normal.
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