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Torsades de Pointes following Synchronized DCCV of SVT

Description

A cardiac rhythm strip by EMS of a 79 y/o female with history of recovered ejection fraction following takotsubo cardiomyopathy who became acutely short of breath at a funeral and was found to be in a narrow complex tachyarrhythmia up to 237 beats per minute for which synchronized, 100J direct current cardioversion (DCCV) was applied causing degeneration into a wide complex tachycardia that becomes polymorphic with a characteristic twisting QRS of torsades de pointes. Repeat unsynchronized DCCV successfully converted her back to normal sinus rhythm. Admit EKG was only remarkable for prolonged qtc of 505 ms. Electrolytes were normal, however, she was found to have recurrent, reduced ejection fraction of 25% and non-obstructive coronaries concerning for recurrent takotsubo-like disease.

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