A man in his late 50s presented with sudden-onset chest pain followed by a shock from his implantable cardioverter-defibrillator (ICD). His history included a cardiac arrest secondary to ventricular fibrillation resulting in ICD implantation 1 year prior, chronic obstructive pulmonary disease, hypertension, and active tobacco and alcohol abuse. There was no history of hyperlipidemia or family history of coronary artery disease. His initial symptom was paresthesia in the right hand, which progressed up his arm and was followed by chest tightness and dyspnea. Notably, he had 6 similar presentations in the preceding year, but myocardial infarction had been ruled out by serial electrocardiograms (ECGs) and cardiac biomarker results on all occasions.
Miller PE, Czarny MJ, Abraham MR. A Rare Cause of Chest Pain and Ventricular Fibrillation. JAMA Intern Med. 2014;174(7):1173-1175. doi:10.1001/jamainternmed.2014.1809