A previously fit marathon-running 54 year old man was admitted as an emergency having collapsed with chest pain caused by an acute transmural anterior myocardial infarction. He was initially resuscitated by his general practitioner then had recurrent episodes of ventricular flutter and fibrillation requiring continuing cardiopulmonary resuscitation and repeated defibrillation. During ambulance transfer and in the hospital emergency department he received appropriate intravenous antiarrhythmic drug treatment and a total of 63 transthoracic DC shocks, with good cardiac output between shocks. After his condition failed to stabilise in intensive care, an intra-aortic balloon pump was inserted and coronary angiography showed a proximal occlusion of the left anterior descending branch. Coronary angioplasty successfully re-opened the vessel with an excellent angiographic result. The intra-aortic balloon pump was withdrawn the following day and he was well enough to be discharged 7 days later. At 4 weeks he performed a satisfactory maximal exercise test and remains in New York Heart Association functional class I.
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