P407 WHEN A SUPRA–VENTRICULAR TACHYCARDIA SAVES A LIFE

Abstract

Abstract The Case A 76–year–old man came to ER because of palpitations and a worsening chest discomfort. His clinical history included hypertension, dyslipidemia, diabetes and gouth. 12–leads ECG revealed a supraventricular tachycardia with heart rate of 190 bpm. It also demonstrated: widespread deep ST depression involving V2–6, I, II, aVL ST elevation in aVR > V1 (Figure 1). Adenosine (6 mg) intravenous administration led to sinus rhythm restoring with symptoms regression. 12–leads ECG after sinus rhythm restoring demonstrated a ST–T segment normalization (Figure 2). Trans–thoracic echocardiogram, acquired in sinus rhythm, showed a picture of left ventricle systolic dysfunction with ejection fraction of 35% due to a severe hypokinesis of mid–apical wall segments. A moderate mitral regurgitation with central jet was visible. An urgent coronary angiography was performed. It demonstrated a LEFT MAIN CORONARY ARTERY (LMCA) very severe (95%) proximal lesion. Patient was sent to urgent coronary artery bypass grafting (CABG). Discussion Widespread ST depression (with reciprocal STE in aVR) is a common finding in patients with supraventricular tachycardias such as AVNRT or atrial flutter. The significance of this finding in individual patients is unclear and may be due to: rate–related ischaemia (O2 demand higher than supply) unmasking of underlying coronary artery disease (i.e. tachycardia as a “stress test”) a pure electrical phenomenon (e.g. the young patient with SVT who is relatively asymptomatic and has normal coronary arteries). In this case, primary ECG pattern and then echocardiographic findings suggested a potentially lethal coronary artery disease which was confirmed by coronary angiography. Conclusion Sometime a supraventricular tachycardia may be helpful in order to bring out life–threatening disease.