Man with chest tightness and diaphoresis.

Abstract

A 67-year-old male patient with chest tightness and diaphoresis presented to the emergency department 1 hour before admission. The patient had a myocardial infarction with stent implantation history for the left circumflex and right coronary arteries 1 month ago. On arrival, his blood pressure was 85/52 mmHg; pulse rate was 166 bpm, and temperature was 35.6°C. A 12-lead electrocardiogram (ECG) was performed immediately (Figure 1). The emergency physician also performed echocardiography (Figure 2) (Videos 1 and 2). Ventricular tachycardia secondary to a postinfarction left ventricular aneurysm. The patient underwent a 100J synchronized cardioversion and the electrocardiogram returned to sinus rhythm (Figure 3). Continuous intravenous amiodarone was administered. He was admitted to the intensive care unit (ICU), where a cardiologist performed successful radiofrequency catheter ablation. Coronary artery disease is the most common cause of left ventricular aneurysms. Echocardiography is the preferred diagnostic method for left ventricular aneurysms after cardiac events.1 The aneurysm's thin-walled dyskinetic or akinetic segments may be composed of dense scars with viable myocardium channels. It may be the site of origin for ventricular tachycardia.2 Antiarrhythmic drugs and radiofrequency catheter ablation are frequently used to reduce ventricular tachycardia frequency and shocks in patients with implantable cardioverter-defibrillators.3