Unusual Case of an Intramyocardial Tumor Presenting With a Ventricular Tachycardia

Abstract

A 64-year-old man with history of hyperlipidemia and type 2 diabetes mellitus presented with sudden onset of atypical chest pain and dyspnea at rest. He denied palpitations or dizziness. Examination revealed blood pressure of 132/81 mm Hg and a heart rate of 153 bpm. The ECG showed a wide-QRS-complex tachycardia compatible with a sustained monomorphic ventricular tachycardia (Figure 1). An amiodarone drip was started, and the tachycardia abruptly terminated during the infusion. In the ECG performed shortly after (Figure 2), normal sinus rhythm with T-wave inversion (transient) in the lateral leads (I, aVL) was evident, probably related to cardiac memory phenomenon. There was no evidence of further arrhythmias while the patient was maintained on oral amiodarone treatment. A chest x-ray showed moderate cardiomegaly and an abnormal left mediastinal contour owing to a bulge in the surface of the left ventricle (Figure 3A and 3B). A transthoracic echocardiogram was performed, demonstrating a normal-size left ventricle, with mild septal hypertrophy, normal systolic function of both ventricles, and no pericardial effusion. A coronary angiography excluded any occlusive disease but revealed a cardiac mass with multiple “feeding” collaterals from the left anterior descending coronary …