A man in his mid-50s with a medical history of nonspecific T-wave abnormalities on electrocardiogram (ECG) reported new-onset chest discomfort, diaphoresis, and shortness of breath that woke him from sleep. Emergency medical services found him to be in a wide complex tachycardia. He was administered a 150-mg bolus of intravenous amiodarone, which failed to terminate his arrhythmia. He ultimately required synchronized cardioversion with a biphasic direct current shock of 100 J. On arrival to the emergency department, his vital signs were stable. Serum electrolyte levels were within normal range and C-reactive protein was less than 6 mg/dL (to convert to milligrams per liter, multiply by 10). High-sensitivity troponin peaked at 1078 pg/mL. His initial 12-lead ECG is shown in Figure 1A. He continued in sinus rhythm with episodes of nonsustained ventricular tachycardia observed on telemetry, as shown in Figure 1B. Cardiac catheterization revealed patent coronary arteries. Cardiac magnetic resonance imaging was remarkable for a dilated right ventricle with moderately reduced systolic function and transmural late gadolinium enhancement with akinesis and dyskinesis involving the right ventricular (RV) free wall and outflow tract extending to the left ventricular (LV) anterior, septal, and apical segments.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Gan-Xin Yan, MD, PhD, Lankenau Medical Center, Main Line Health, 100 Lancaster Ave, Wynnewood, PA 19096 (email@example.com).
Published Online: January 4, 2023. doi:10.1001/jamacardio.2022.4888
Conflict of Interest Disclosures: Dr Yan is supported by grants from the Sharpe-Strumia Research Foundation. No other disclosures were reported.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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