Case
I have a 16-year old young man with history of an aborted sudden cardiac arrest and an implanted cardioverter defibrillator (ICD) who presented to urgent care this evening. Earlier today he was playing basketball with some friends and he said that he felt someone punch him really hard in the back. He didn’t know who did it so he just kept playing. Later in the evening after coming back from school he was lying on the couch watching TV. His mother called him for dinner and as he got up off the couch and started to head to the kitchen he felt a thump as though he got kicked in the chest and immediately fell to the ground. His mother saw him fall and checked to see if he was OK and he appeared fine but was in pain. She brought him in here. I have ordered a chest X-ray to check it out. Anything else I can do?
What am I thinking?
From the description of the events, it sounds like that this young man has received a “discharge” or shock from his ICD. The next question to answer is was it an “appropriate” or “inappropriate” shock? Any patient that received or is thought to have received a discharge from their ICD should have an immediate interrogation of their device (see Figs. 28.1 and 28.2 ). Modern ICD systems can allow for remote monitoring that allows patients to provide self-interrogation of their device that can be sent electronically to their electrophysiologist. However, such systems do not allow for programming of the device that may be required. Therefore, it is not uncommon for individuals with ICDs who have received shocks to seek care in an emergency room or urgent care.
