You are here

Article Text

Article menu
Download PDFPDF
Image challenge
A shocking twist
  1. Paul D Morris1,2,3,
  2. Eron Yones1,
  3. David R Warriner1
  1. 1 Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  2. 2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
  3. 3 Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Paul D Morris, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S102RX, UK; paul.morris{at}sheffield.ac.uk

https://doi.org/10.1136/emermed-2016-206347

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Clinical introduction

    A 61-year-old man presented to the ED after receiving multiple shocks from his cardiac resynchronisation therapy-defibrillator (CRT-D) device, implanted 2 months previously for New York Heart Association (NYHA) class III heart failure and left bundle branch block (LBBB). He had hiccoughs and was anxious but denied chest pain and dyspnoea. He had chronic atrial fibrillation (AF). He was haemodynamically stable but received several further unheralded shocks. The cardiac monitor appeared to show AF and LBBB throughout. His presenting chest radiograph is demonstrated in figure 1.

    Figure 1

    The ED chest radiograph.

    Question

    What is the most likely cause for this man's CRT-D firing?

    1. Lead fracture

    2. Lead migration …

    View Full Text

    Footnotes

    • Contributors PDM conceived the original idea for the article. PDM, EY and DRW were all involved in writing and editing of the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.