46
Table 8. Clinical scenarios for end-of-life management in
patients with NMD
Clinical scenario
4. A 46-year-old woman with DM1 and severe neuromuscular impairment
(nonambulatory, nocturnal oxygen supplementation) presents for first cardiac
EP evaluation with referral from neurology service. No symptoms attributable to
cardiac involvement or arrhythmias are noted. The ECG shows sinus rhythm, PR
interval 260 ms, RBBB, and left anterior fascicular block with QRS duration
140 ms. Echocardiogram shows LVEF 55% without other significant abnormalities.
Shared Decision-making and End-of-life Care
(cont'd)
