Abstract
A 44-YEAR-OLD MAN WITH A NONISCHEMIC DIlated cardiomyopathy treated with an implanted left ventricular assistdevice (LVAD) was admitted to our hospital for diuresis after presenting with acute decompensated heart failure. His admission blood pressure was 95/65 mm Hg. Serial troponin measurements were negative. While hospitalized, the patient developed a wide complex tachycardia on telemetry monitoring resulting in multiple successive discharges from his implantable cardioverterdefibrillator (ICD). On evaluation, the patient was conversant and without complaint of lightheadedness or palpitations. Bilateral radial and femoral pulses were absent. An automated cuff was unable to measure a brachial blood pressure in either arm. An electrocardiogram (ECG) was obtained (Figure 1). Question: How can the patient’s ECG be reconciled with his clinical appearance and physical findings?
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