We report a unique case of delivery of inappropriate implantable cardioverter-defibrillator therapies related to a “perfect storm”: presence of an integrated lead, insufficient lead slack related to right heart dilation resulting in shock coil misplacement, myocarditis with loss of R waves, and the concomitant occurrence of an incessant atrial tachycardia. ( Level of Difficulty: Advanced. )

Cardiovascular disease (CVD) remains the leading cause of death in American women. Despite advancements in the management of CVD, the death rates have plateaued over the past decade, particularly in females under the age of 65. 1,2 One third of new-onset cardiovascular events in women occur before the age of 65, which emphasize the need for improved screening strategies in younger women to target preventative therapies. 3 When assessing women for primary prevention of CVD, several risk scores exist with the most recent being the atherosclerotic cardiovascular disease (ASCVD) risk score, also known as the pooled

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