A woman in her mid-40s presented to the emergency department after a fall with head trauma. A head computed tomography showed a 0.9-cm left subdural hematoma with a mild left to right midline shift. Her ethanol level was 202 mg/dL (to convert to millimoles per liter, multiply by 0.2171); magnesium, 1.7 mg/dL (to convert to millimoles per liter, multiply by 0.4114); potassium, 4.4 mEq/L (to convert to millimoles per liter, multiply by 1); and ionized calcium, 4.6 mg/dL (to convert to millimoles per liter, multiply by 0.25). The patient developed cardiac arrest due to ventricular arrhythmias in the emergency department and was successfully resuscitated. Echocardiography demonstrated a left ventricular ejection fraction of 50% and no regional wall motion abnormalities. She subsequently underwent embolization of the middle meningeal artery. After embolization, however, a worsening rightward midline shift was discovered. As a result, on the 11th day of her hospitalization, she had a burr hole evacuation. During day 15 of admission, the patient had 3 episodes of torsade de pointes (TdP) while receiving 50 mg of metoprolol succinate daily, and her 12-lead electrocardiogram (ECG) is shown in Figure 1.
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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: Tanyanan Tanawuttiwat, MD, MPH, Division of Cardiovascular Medicine, Indiana University, 1800 N Capitol Ave, Room 300B, Indianapolis, IN 46202 (email@example.com).
Published Online: January 18, 2023. doi:10.1001/jamacardio.2022.5094
Conflict of Interest Disclosures: Dr Miller reports fellowship support and lecture fees from Medtronic, Boston Scientific, Biosense-Webster, Abbott Electrophysiology, and Biotronik, Inc.
Additional Contributions: The authors are grateful to Peng-Seng Chen, MD, for his invaluable suggestions. We also thank the patient for granting permission to publish this information.
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.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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