Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents, Unusual setting of medical care, Clinical situation which can not be reproduced for ethical reasons
Michelle Audrey Darmadi, Axel Duval, Hanaa Khadraoui, Alberto N. Romero, Blanca Simon, Justyna Watkowska, Henock Saint-Jacques
Department of Cardiology, Harlem Cardiology, New York City, NY, USA
Am J Case Rep 2020; 21:e928242
Available online: 2020-10-28
Exercise-induced ventricular tachycardia (VT) has been widely reported in patients with preexisting structural heart disease or underlying ischemia and is attributed to reentry tachycardia and abnormal automaticity. However, studies regarding exercise-induced VT in individuals without evident structural heart disease are still limited.
CASE REPORT: A 51-year-old woman came to our practice for a treadmill stress echocardiogram. The patient experienced only mild chest discomfort and was otherwise asymptomatic. Cardiovascular risk factors were significant only for obesity and positive family history of coronary artery disease in the mother. During the exercise stress test, the patient developed wide complex VT with multiple capture beats accompanied by nausea and dizziness, which lasted approximately 2 minutes before resolving spontaneously. Subsequent evaluation with magnetic resonance imaging, transthoracic echocardiography, and coronary angiography revealed an absence of apparent structural heart disease.
CONCLUSIONS: Exercise-induced VT in the absence of structural heart disease, although rare, can pose a life-threatening event and requires different considerations for management. The benefits of currently available therapeutic options have yet to be elucidated for this subset of patients. Thus, we assert that there is a need for further investigation on the approach of exercise-induced VT in patients without structural heart disease.
Keywords: Echocardiography, Stress, Heart Diseases, Tachycardia, Ventricular