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Implantable Cardioverter Defibrillator Alert in Dextrocardia with Transposition of the Great Arteries

HeartRhythm

A 50-year-old woman with dextrocardia and D-transposition of the great arteries presented with a “RV defib lead impedance” remote-monitoring alert from her implantable cardioverter defibrillator (ICD). The superior limb of the baffle was stenosed and required stenting. An epicardial pacemaker was implanted.

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Completely Wireless: First Concomitant Dual Chamber Leadless Pacemaker and Subcutaneous Defibrillator Implant

HeartRhythm

While in the hospital, he had witnessed ventricular fibrillation (VF) arrest for which he received external defibrillation. He had minimal in-stent restenosis on angiography but had only minimal cardiac enzyme elevation and did not have antecedent chest pain before either of his events.

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Cardiac Arrest, Ventricular Fibrillation, Inferior and Right ventricular MI (RVMI) or "Pseudoanteroseptal MI"

Dr. Smith's ECG Blog

She was defibrillated successfully from ventricular fibrillation and developed a perfusing rhythm. Pressors were required, and the patient was transported to the cath lab with a door to balloon time of 60 minutes, where a proximal dominant RCA occlusion was opened and stented. She was intubated.

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Abstract 4143264: A Case of Spike-on-T Phenomenon and Polymorphic Ventricular Tachycardia

Circulation

We describe a case of ventricular pacemaker spikes delivered on the T wave causing PMVT.Case:A 53-year-old female with CAD s/p stent, postpartum cardiomyopathy s/p Bi-V CRT-D (Boston Scientific G124), and paroxysmal atrial fibrillation presented for elective endoscopy and colonoscopy to evaluate her dysphagia and abdominal pain.

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Cardiac arrest: even after the angiogram, the diagnosis is not always clear

Dr. Smith's ECG Blog

She was found to be in ventricular fibrillation and was defibrillated 8 times without a single, even transient, conversion out of fibrillation. She was immediately intubated during continued compressions, then underwent a 9th defibrillation, which resulted in an organized rhythm at 42 minutes after initial arrest. It was stented.

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Chest pain and a "normal" ECG

Dr. Smith's ECG Blog

After the second defibrillation the patient had an organized rhythm: Bradycardic escape/agonal rhythm, with large ST deviations. The patient was taken back to the cath lab, where 100% proximal in-stent rethrombosis was found and treated. It should have been shocked at least 10 seconds ago. This is diagnostic of re-occlusion.

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Distractions

EMS 12-Lead

He denied any known medical history, specifically: coronary artery disease, hypertension, dyslipidemia, diabetes, heart failure, myocardial infarction, or any prior PCI/stent. Despite immediate chest compressions, and multiple rounds of defibrillation, he could not be resuscitated. No appreciable skin pallor.