A curious case of upper limb ischemia associated with deep vein thrombosis following cardioversion for ventricular tachycardia

Abstract

Acute upper limb ischaemia is an uncommon vascular emergency that may result in irreversible limb loss. Thromboembolic complications following cardioversion for ventricular tachycardia remain poorly characterised. We report the case of a 70-year-old woman with type 2 diabetes mellitus who underwent direct-current cardioversion for haemodynamically unstable ventricular tachycardia. Subsequently, she developed acute pain, numbness, and bluish discolouration of the left upper limb, with absent brachial and radial pulses and complete loss of distal motor and sensory function. Duplex ultrasonography demonstrated absent flow in the brachial, radial, and ulnar arteries. Echocardiography revealed global left ventricular hypokinesia with an ejection fraction of 30%, without intracardiac thrombus. Concurrent right lower limb deep vein thrombosis was identified. The limb was classified as Rutherford class III acute limb ischaemia, necessitating above-elbow amputation. This case highlights a severe vascular complication temporally associated with cardioversion for ventricular tachycardia, emphasising early recognition, prompt vascular assessment, and timely intervention to prevent irreversible ischaemic injury.