UMEM Educational Pearls

Category: Visual Diagnosis

Title: What's the Diagnosis?

Posted: 10/20/2013 by Haney Mallemat, MD (Emailed: 10/21/2013) (Updated: 10/21/2013)
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55 year-old male presents with chest pain. You take a look at his cardiac function with ultrasound and here's the patient's apical four-chamber view. What's in his right ventricle and why would it be there?



  • Automatic Implantable Cardioverter-Defibrillator (AICD); Pacemaker could also be the answer as it is difficult to distinguish on ECHO.
  • It was placed in this patient for primary prevention of VT/VF secondary to a chronically low left-ventricular ejection fraction. 


  • Placed for patients at risk for sudden cardiac death secondary to malignant arrhythmias (e.g., ventricular tachycardia / fibrillation)
  • Shown to improve mortality for patients with severe left ventricular dysfunction (EF<30%) and has been shown to improve mortality (as in this case)
  • Tricuspid regurgitation is caused by the intra-cardiac lead preventing complete closure of tricuspid valve leaflets.


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