A patient in their 40s with a history of remote coronary artery bypass grafting, heart failure with reduced ejection fraction, and poorly controlled insulin-dependent diabetes was admitted to the cardiac intensive care unit with acute decompensated heart failure. The patient’s baseline electrocardiogram (ECG) demonstrated normal sinus rhythm, with normal PR and QRS intervals at 132 and 82 milliseconds, respectively. With poor response to intravenous (IV) diuretics, the patient underwent right heart cardiac catheterization, which demonstrated a low cardiac index, high left ventricular filling pressure, and elevated systemic vascular resistance. The patient’s outpatient use of metoprolol was discontinued, and IV dobutamine (5.0 µg/kg/min) was initiated with continuing aggressive IV diuresis. While defecating on the bedside commode, the patient became lightheaded and unresponsive. The patient’s pulse was barely palpable, and the ECG rhythm showed bradycardia (Figure).
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Tsushima T, Patel TR, Sahadevan J. Unusual Cause of Cardiac Arrest. JAMA Intern Med. 2021;181(4):542–543. doi:10.1001/jamainternmed.2020.8370
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