by Maygen del Castillo, MD, Ihab Hamzeh, MD, FACC, and Yochai Birnbaum, MD, FACC
A 55-year-old man with a history of coronary artery bypass grafting and severe biventricular failure presented with several weeks of shortness of breath and associated chest pain. He needed an Impella® heart pump (Abiomed, Inc.) as mechanical circulatory support for volume overload and cardiogenic shock. His mildly elevated cardiac troponin I level (1.35 ng/mL on admission) was attributed to demand ischemia from decompensated heart failure; the level decreased after diuresis. He was referred for advanced heart failure evaluation. Figure 1 shows his electrocardiogram (ECG) on presentation.
