Quiz

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  Sustained tachycardia as a cause of cardiomegaly was first described by Phillips and Levine in 1949. This was subsequently verified when rapid ventricular pacing in animal models produced progressive dilated cardiomyopathy. The combination of rapid uncontrolled heart rate and otherwise unexplained heart failure (HF) should raise the consideration of a reversible form of cardiomyopathy.
   Initial therapy in this patient with atrial fibrillation and HF should be aimed at controlling the ventricular rate and restoring a sinus mechanism.
   After resolution of a sinus mechanism, improvement in ejection fraction from 35% to 50% and resolution of failure symptoms were seen within three months.