A 37-year-old man without a significant medical history had an out-of-hospital sudden cardiac arrest. A bystander started cardiopulmonary resuscitation, and emergency medical services arrived promptly, confirmed ventricular fibrillation, and restored sinus rhythm. An emergent coronary arteriogram was normal. Transthoracic echocardiography revealed a severely reduced left ventricular ejection fraction and suggested left ventricular noncompaction. The patient's heart failure with reduced ejection fraction was treated with carvedilol, lisinopril, and spironolactone, and after he was weaned from the ventilator he received an implantable cardioverter-defibrillator. The patient's identical twin was treated in the same fashion for a sudden cardiac arrest. Although many experts think that left ventricular noncompaction cardiomyopathy is a distinct nosological entity, others think that it is simply a dilated cardiomyopathy with unusually prominent left ventricular trabeculae.
A 60-year-old man with a history of high blood pressure, type 2 diabetes mellitus, end-stage kidney disease on hemodialysis, and a hemorrhagic stroke within the past year with neurologic residua was brought from the nursing home to the hospital because of fever and an altered mental state and was found to have pneumonia. Serum electrolytes were normal, and an echocardiogram showed normal left ventricular systolic function. A 12-lead electrocardiogram, however, was abnormal (Figure 1).The initial portion of the electrocardiogram shows sinus rhythm at a rate of 65 beats per minute. The fifth QRS is premature and has a different morphology than the four previous QRSs. Thereafter, all of the QRSs are wide, and the rhythm is regular at a rate of 94 beats per minute. This is an accelerated idioventricular rhythm, and the fifth QRS is probably a fusion complex resulting from the simultaneous occurrence of the QRS of a supraventricular premature complex and the first idioventricular complex. The R-R Figure 1. Electrocardiogram in a 60-year-old man admitted to the hospital from a nursing home because of fever and an altered mental state.
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