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JAMA Cardiology Clinical Challenge
November 7, 2018

Wide Complex Tachycardia and Syncope in a Middle-aged Woman

Author Affiliations
  • 1Division of Medicine, University of Missouri, Kansas City
  • 2Division of Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
  • 3Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
JAMA Cardiol. 2019;4(3):295-296. doi:10.1001/jamacardio.2018.3687

A woman in her late 40s with a history of hypertension presented to the emergency department after multiple episodes of palpitations with near syncope. While in the emergency department, she developed monomorphic ventricular tachycardia (VT) with hemodynamic instability and was successfully cardioverted. She continued to have nonsustained monomorphic VT, so intravenous amiodarone and oral metoprolol were initiated. She was admitted for further evaluation. Results of tests of electrolyte levels and coronary angiography were normal. Cardiac magnetic resonance imaging with gadolinium contrast revealed normal-sized cardiac chambers and normal biventricular function without delayed enhancement. The presenting electrocardiogram (ECG) is shown in Figure 1.

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