Ventricular Tachycardia and The Diagnosis of a Metallic Intracardiac Foreign Body

Abstract

A man with a history of metallic shrapnel injury from a chisel 40 years ago presented for an elective exercise stress test due to ‘stinging’ central chest pains. After 5 minutes 48 seconds the stress test was stopped due to asymptomatic ventricular tachycardia. He was referred urgently for angiography which showed non obstructive coronaries but noted a small metal fragment lodged into the right ventricular wall. Follow up CT imaging confirmed the new finding of a 5mm intracardiac metallic foreign body. Further angiography at the site of the previous injury showed no residual metallic fragment. CT imaging also identified an incidental bronchogenic neoplasm for which he underwent lobar resection with fifteen negative nodes. No further cardiac intervention was performed. He recovered well post operatively and was followed up six months later with no arrythmi as or signs of metastatic spread.