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Pacemakers & AICDs in the ED — what really matters when every shock counts. Dr. Swaminathan and Dr. Tarlan Hedayati break down a practical, stepwise approach to evaluating patients with cardiac devices. When an AICD fires, the differential stays wide: the shock may be appropriate, inappropriate, or even unnoticed by the patient. Start with a standard workup, evaluate for ischemia, and remember that a rising troponin should push you toward admission. A single shock doesn’t always mean the patient
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