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Managing monomorphic ventricular tachycardia without cardioversion: A case report.

ABSTRACT: Cardiovascular diseases account for nearly 31% of global deaths. Ventricular arrhythmia cause 1-2 in 1000 sudden cardiac deaths. Patient with a known case of coronary artery disease presented with complaints of heaviness in the chest with pain radiating to the left shoulder joint with sweating and dizziness for 6 months. The patient was diagnosed as monomorphic ventricular tachycardia (mVT) and left ventricular hypertrophy (LVH) based on electrocardiograph (ECG) findings. Treatment planned to bring Agni, Rasa, Vata Dosha into homeostasis. mVT is completely cured in 24 days of Ayurvedic treatment. The electrocardiograph was normal after the course of treatment. In this case report, we treated the patient with monomorphic ventricular tachycardia with Ayurvedic treatment. This case report provides guidance for heart disease management with Ayurveda.

SUBMITTER: Kajaria D

PROVIDER: S-EPMC10307682 | biostudies-literature | 2023 Mar-Apr

REPOSITORIES: biostudies-literature

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Managing monomorphic ventricular tachycardia without cardioversion: A case report.

Kajaria Divya D Khobarkar Punam Namdeo PN

Journal of Ayurveda and integrative medicine 20221112 2

Cardiovascular diseases account for nearly 31% of global deaths. Ventricular arrhythmia cause 1-2 in 1000 sudden cardiac deaths. Patient with a known case of coronary artery disease presented with complaints of heaviness in the chest with pain radiating to the left shoulder joint with sweating and dizziness for 6 months. The patient was diagnosed as monomorphic ventricular tachycardia (mVT) and left ventricular hypertrophy (LVH) based on electrocardiograph (ECG) findings. Treatment planned to br ...[more]

PMID: 36376204

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Clinical Presentation of Sustained Monomorphic Ventricular Tachycardia Without Cardiac Arrest.

Project description:Background "Palpitations" are one of the most common complaints prompting medical attention. Textbooks of medicine and cardiology as well as guideline documents and position papers describe palpitations as a common symptom of ventricular tachycardia (VT). However, data to support this description are lacking. The aim of our study was to evaluate the symptomatology of sustained monomorphic VT with emphasis on the prevalence of palpitations. Methods and Results Consecutive patients presenting to our center with a first event of a regular sustained monomorphic VT (n=59) or a regular supraventricular tachycardia (SVT; n=109) between January 2012 and September 2019 were interviewed regarding their symptoms during the arrhythmic event. We included only patients with a first arrhythmic event to avoid the influence of previous medical encounters on our patients' terminology. As expected, patients with VT were older (age 68.8±13.6 versus 52.6±16.8 years; P<0.001), more often of male sex (94.9% versus 37.6%; P<0.001), had lower left ventricular ejection fraction (37±11% versus 59±2%, P<0.001) and more comorbidities (87.6% versus 40.5%; P<0.001) compared with patients with SVT. Importantly, even though the heart rate upon presentation did not differ between the 2 groups (165±26 beats/min during VT versus 171±32 beats/min during SVT; P=0.16), symptomatology differed significantly; specifically, palpitations were reported in only 8.8% of VT patients, compared with 90.7% of SVT patients (P<0.001). Common symptoms in the VT group included chest pain (64%), dyspnea (21%), and dizziness (26%). Conclusions Despite similar heart rate, patients with VT rarely report having palpitations, whereas patients with SVT do so commonly. This finding may assist with decision making in patients reporting palpitations in whom an ECG tracing is not available.

| S-EPMC7763738 | biostudies-literature

Bullet-associated ventricular tachycardia: a case report.

Project description:BackgroundThe majority of ventricular tachycardias (VTs) occurs in patients with structural heart disease and is associated with an increased risk of sudden cardiac death. These VT are scar-related and may develop in patients with ischaemic or non-ischaemic cardiomyopathies.Case summaryWe describe a 44-year-old patient without any pre-existing cardiovascular disease, presenting with the first documentation of a haemodynamically unstable sustained fast VT with a cycle length of 250 ms. He reported a suicidal attempt with a self-made handgun aged 16 when he had shot himself in the thorax and had injured the myocardium. After presenting with the VT coronary artery disease was excluded through cardiac catheterization. A cardiovascular magnetic resonance study showed a localized myocardial scar in the left ventricular free wall starting from the subepicardium and correlating to the scar described 28 years ago by the thoracic surgeons. In an electrophysiological study, non-sustained VT were easily inducible. Presuming a causal relationship between the fast VT and the epicardial scar, a single-chamber implantable cardioverter-defibrillator was implanted and beta-blocker therapy was initiated.DiscussionScar-related VT often occur many years after an acute event, e.g. an acute myocardial infarction. This case highlights, that any cardiac trauma, even a superficial epicardial projectile-related damage with subsequent scarring, may cause a VT after many years and to our knowledge for the first time describes the occurrence of a VT due to mechanical damage to the myocardium by a gunshot.

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Electrical organization of torsades de pointes into monomorphic ventricular tachycardia.

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Congenital Double-Chambered Left Ventricle Presenting as Monomorphic Ventricular Tachycardia.

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Ventricular tachycardia: a presentation of Fabry disease case report.

Project description:BackgroundFabry disease is an inherited rare metabolic disease caused by mutation in the GLA gene, encoding lysosomal enzyme alpha-galactosidase A. The disorder is a systemic disease that manifests as cerebrovascular and cardiac disease, chronic renal failure, skin lesion, peripheral neuropathy, and other abnormalities. Ventricular tachycardia as a Fabry disease presentation is very rare.Case summaryA 36-year-old man self-presented to a general practitioner complaining of episodes of shortness of breath together with a 6-month history of malaise. The 12-lead electrocardiogram (ECG) prompted a decision to transfer him immediately to a percutaneous coronary intervention (PCI) capable hospital under the suspicion of acute coronary syndrome. Whilst awaiting transport, he experienced acute onset of dyspnoea together with non-specific chest heaviness. A repeat ECG monitor strip showed ventricular tachycardia transforming to ventricular fibrillation. The patient was successfully defibrillated. Coronary angiography was performed upon arrival at hospital and demonstrated unobstructed coronary arteries. Transthoracic echocardiography revealed concentric left ventricular hypertrophy (LVH) and normal systolic function, with severe diastolic dysfunction. Magnetic resonance imaging (MRI) confirmed the LVH, and did not demonstrate any late gadolinium enhancement.DiscussionOur case illustrates the pivotal role of critical clinical thinking in the diagnosis of rare but treatable hereditary cardiomyopathy. The uncommon cardiac presentation of Fabry disease promotes further research linking different phenotypes of Fabry disease with different pathogenic mutations.

| S-EPMC6439386 | biostudies-literature

Pharmacological cardioversion of supraventricular tachycardia in pregnancy during continuous electrophysiological foetal monitoring: a case report.

Project description:BackgroundMaternal tachycardia is the most frequently occurring cardiac complication during pregnancy. Often administration of drugs is required as a treatment. The drug of choice is intravenously administered adenosine because it is considered safe, though there are limited studies regarding safety for the foetus with the use of adenosine.Case summaryWe report a conversion of maternal atrio-ventricular (AV) nodal reentry tachycardia during pregnancy with the use of intravenous adenosine whilst continuous electrophysiological foetal monitoring. Four seconds after the maternal conversion, the foetal tracing suggests the presence of a ventricular extrasystole or a transient AV block.DiscussionThis case report illustrates that the administration of adenosine intravenously during pregnancy could have an effect on the foetal conduction system. Therefore, further investigation to assess the electrophysiological effect of adenosine on the foetal electrocardiogram seems required.

| S-EPMC9168670 | biostudies-literature

Cardiac sarcoidosis mimicking arrhythmogenic right ventricular dysplasia in a patient presenting with monomorphic ventricular tachycardia.

Project description: Not available

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Adenosine sensitive left ventricular summit ventricular tachycardia in a pre-adolescent: case report

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A case of arrhythmogenic right ventricular cardiomyopathy presenting with progressive right ventricular failure and recurrent multifocal monomorphic ventricular tachycardia during 15 years of follow-up.

Project description:Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a multigenic form of cardiomyopathy characterized by myocardial loss and fibrofatty replacement mainly in the right ventricle. Progressive right ventricular dysfunction, ventricular arrhythmias, and sudden cardiac death are the clinical picture of this disease. Despite its clinical importance as a cause of sudden death, ARVC is likely to be under-recognized. In case reports about ARVC, disease characteristics such as arrhythmias, images, and genes are described in fragments. Little is reported about the long-term course of ARVC in the same patient. In this report, we present a case of a 68-year-old male who was diagnosed with ARVC after his first episode of ventricular tachycardia. Both mechanical and electrical progression were seen during the 15 years of follow-up, requiring the modification of disease management. This report could help improve the understanding of this rare disease, and the way of its management. <Learning objective: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a multigenic form of cardiomyopathy characterized by fibrofatty degeneration mostly in right ventricular myocardium. Despite its importance as a cause of sudden death, ARVC is likely to be under-recognized. This paper describes the progressive course of ARVC confirmed both clinically and pathologically during 15 years of follow-up, which could help improve understanding of this disease.>.

| S-EPMC6279640 | biostudies-literature

Case report: successful termination of ventricular tachycardia by intrinsic anti-tachycardia pacing beyond conventional anti-tachycardia pacing.

Project description:BackgroundAnti-tachycardia pacing (ATP) is a pain-free alternative to defibrillation shock for monomorphic ventricular tachycardia (VT). Intrinsic ATP (iATP) is a novel algorithm of auto-programmed ATP. However, the advantage of iATP over conventional ATP in clinical cases is still unknown.Case summaryA 49-year-old man with no significant past medical history was transferred to our institution with sudden-onset fatigue from working on a farm. A 12-lead electrocardiogram showed monomorphic sustained wide QRS tachycardia with a right bundle branch block pattern and superior axis deviation with a cycle length (CL) of 300 ms. Sustained monomorphic VT originating from the left ventricle due to underlying vasospastic angina was diagnosed by contrast-enhanced cardiac magnetic resonance imaging, coronary angiography, and the acetylcholine stress test, and implantable cardioverter defibrillator implantation was performed. Nine months later, a clinical VT episode with a CL of 300 ms was observed, which could not be terminated by three sequences of conventional burst pacing. Ventricular tachycardia was finally terminated by a third iATP sequence without any acceleration.DiscussionAlthough standard burst pacing by conventional ATP reached the VT circuit, it failed to terminate the VT. Using the post-pacing interval, iATP automatically calculated the appropriate number of S1 pulses required to reach the VT circuit. In iATP, the S2 pulses are delivered with a calculated coupling interval based on the estimated effective refractory period during tachycardia. In this case, iATP might have led to less aggressive S1 stimulation, followed by aggressive S2 stimulation, which probably helped terminate the VT without any acceleration.

| S-EPMC10328381 | biostudies-literature

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