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Swinging heart and vector alternans: signs of impending doom
  1. Lovely Chhabra1,
  2. David H Spodick2
  1. 1Department of Internal Medicine, Saint Vincent Hospital, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  2. 2Department of Cardiovascular Medicine, Saint Vincent Hospital, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  1. Correspondence to Dr Lovely Chhabra, Department of Internal Medicine, Saint Vincent Hospital, University of Massachusetts Medical School, 285 Plantation Street, # 813, Worcester, MA 01604, USA; lovids{at}hotmail.com

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An 80-year-old man with history of atrial flutter and tachy-brady syndrome presented to our hospital with dyspnoea and hypotension. Two days prior, he had undergone atrial flutter ablation and permanent pacemaker placement, and was discharged on dabigatran. Physical examination was remarkable for hypotension, tachycardia, elevated jugular venous pressure (JVP) and pulsus paradoxus. 12-lead ECG revealed atrial flutter and QRS electrical alternans …

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