A patient in their 60s was admitted to the intensive care unit for gastrointestinal bleeding and shock associated with liver cirrhosis, portal hypertension, and ruptured esophageal varices. Emergency treatment included balloon tamponade of the esophagus, blood transfusions, octreotide, and vasopressin. Despite fluid resuscitation and the use of pressors, the blood pressure continued to fall, and the kidney function progressively deteriorated. Computer interpretation of a 12-lead electrocardiogram (ECG) indicated supraventricular tachycardia with right bundle-branch block and right superior QRS axis (Figure, A). The interpretation software also reported frequent premature ventricular complexes. The patient’s baseline ECG recorded a few months earlier was normal.
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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: Laszlo Littmann, MD, PhD, Department of Internal Medicine, Atrium Health Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232 (firstname.lastname@example.org).
Published Online: March 13, 2023. doi:10.1001/jamainternmed.2022.6613
Conflict of Interest Disclosures: None 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.
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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