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Challenges in Clinical Electrocardiography
December 2015

A Young Woman With Heart Failure and Altered Mental Status—The Answer in the Electrocardiogram

Author Affiliations
  • 1Department of Internal Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
  • 2Department of Cardiology, Vanderbilt University School of Medicine, Nashville, Tennessee
  • 3Department of Cardiology, Duke University School of Medicine, Durham, North Carolina
JAMA Intern Med. 2015;175(12):1968-1969. doi:10.1001/jamainternmed.2015.6137

A woman in her late teens with a 1-year history of viral cardiomyopathy presented with decompensated heart failure. The patient’s echocardiogram was notable for a left ventricular ejection fraction of 20% to 25%. Physical examination was notable for bibasilar crackles on lung auscultation and lower-extremity edema. The patient was started on intravenous (IV) diuretic therapy, an IV milrinone infusion, and IV calcium therapy (as adjuvant therapy for ionotropic support; unknown dose). Over the next 5 days, she improved clinically and passed 7 liters of urine.

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