This case highlights the unique clinical presentation of pulseless atrial fibrillation with unmeasurable blood pressure in a conscious patient supported by a continuous-flow LVAD.
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LVAD patients may present conscious without measurable pulse or BP during AF; case report leaves open broader diagnostic validation.
Case PresentationA 65-year-old man presented to the emergency room with shortness of breath that started 3 hours earlier.He was referred from another clinic with the ECG diagnosis of atrial fibrillation with a slow ventricular response.Shortly after presentation, the patient showed signs of worsening heart failure.The patient had a history of mechanical aortic valve prosthesis and subpectoral implantation of a transvenous biventricular pacemaker system.A DeBakey left ventricular assist device (LVAD) was implanted 7 weeks ago due to end-stage heart failure with severely decreased left ventricular systolic function.The patient remained conscious, but his pulse and blood pressure were not measurable; oxygen saturation was 96%.
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Lemola et al. (2004) studied this question.
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