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

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.