PDF           PRINT VERSION      Comments      

Quiz on electrophysiology and case report

The ICD patient with chest pain

Dolly Marope¹, Ashutosh Hardikar¹,  Keshav Bhattarai¹,  Jonathan A. Lipton^1,2

¹Royal Hobart Hospital, Australia

²University of Tasmania, Australia

An 81-year-old male was admitted after an out-of- hospital cardiac arrest and had a secondary prevention implantable cardioverter defibrillator (ICD) implanted. One day after implantation, he complained of symptoms of chest discomfort. Vital signs are stable and physical examination of the chest is unremarkable.

Question 1. What is the next most appropriate step in the evaluation of chest discomfort in this patient?

A) Coronary angiography

B) Chest X-ray

C) 12-lead electrocardiogram

D) Echocardiogram

Further investigations were performed and resulted in a chest computed tomography (see Fig. 1).

 

Question 2. What is the most appropriate management of the diagnosis observed on the image?

A) Non-steroidal anti-inflammatory drugs and Colchicine 0.5mg twice daily for 6 weeks with echocardiographic follow-up.

B) Emergency thoracotomy with removal of the ICD lead.

C) Placement of chest tube and follow-up chest X-ray.

D) Percutaneous revision of ICD lead in operating theatre with cardiothoracic back-up available.