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Table 8. Clinical scenarios for end-of-life management in
patients with NMD
Clinical scenario
1. A 62-year-old woman with DM1, nonischemic CM (LVEF 24%), LBBB, and
previous biventricular ICD implantation is admitted with recurrent aspiration
pneumonitis. She uses a wheelchair for all mobility, has a tracheostomy from prior
pneumonia requiring prolonged mechanical ventilation, and had an enterostomy
inserted 1 year ago. End-of-life management and planning is discussed.
2. A 39-year-old woman with Emery-Dreifuss muscular dystrophy type 1 (EDMD1),
AF, and a history of lower extremity arterial thromboembolism is hospitalized
following traumatic intracranial hemorrhage associated with an accidental fall while
on warfarin therapy. At baseline, she required assistance with activities of daily
living and ambulated with a walker or wheelchair only. She remains lethargic and
noncommunicative.
Shared Decision-making and End-of-life Care
