A woman in her late 60s presented to the emergency department after an episode of syncope. She described several other episodes occurring at rest over the past several weeks. She denied palpitations, chest pain, and shortness of breath. She was otherwise in excellent health and not taking any medications. She had no family history of syncope or sudden death. Her vital signs and physical examination were unremarkable. The initial electrocardiogram (ECG) results were normal, but premature ventricular contractions (PVCs) were noted on telemetry. Shortly thereafter, 2 episodes of fast polymorphic ventricular tachycardia (PVT), 30 minutes apart, were recorded, both lasting less than 4 seconds (Figure 1A). A repeat ECG showed PVCs (Figure 1B). Laboratory test results including serum potassium and magnesium as well as 3 serial troponin levels were normal. Echocardiography showed normal left ventricular systolic function without wall motion abnormalities or valvular abnormalities. Coronary angiography showed a 50% stenosis of the left circumflex artery. Instant wave-free ratio across the stenosis was 1.0.
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Corresponding Author: Mazen M. Kawji, MD, OSF Cardiovascular Institute, 1050 E Norris #1A, Ottawa, IL 61350 (email@example.com).
Published Online: May 17, 2023. doi:10.1001/jamacardio.2023.1053
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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