Ventricular tachycardia associated with a left ventricular apex sump aneurysm in an adolescent

Abstract

beneficial effects of diltiazem were followed by an associated subjective improvement over an 11-month period.’ In this report we describe a late-stage patient who sustained a significant improvement with nifedipine over a 6-month period. This improvement was associated with a significant change in hemodynamic data measured repeatedly. A white female patient (age 27 years) was admitted for evaluation of progressive dyspnea and syncope on exertion. At the age of 20 years she was known to have cardiomegaly. Her blood pressure was 115/75 mm Hg. There was clinical evidence of right ventricular hypertrophy. On auscultation a loud pulmonic closure sound was followed by a long early diastolic murmur of pulmonary regurgitation. Routine laboratory examinations were normal. The ECG showed right axis deviation and right ventricular hypertrophy. The chest x-ray showed cardiomegaly and central pulmonary arterial dilatation with distal vessel narrowing. A pulmonary angiogram revealed no signs of pulmonary emboli. The most important hemodynamic data are shown in Table I. The pulmonary capillary wedge pressure was normal. After treatment with nifedipine, 20 mg six times a day, significant improvement of hemodynamic data was seen after 3 days. During the follow-up period, symptoms markedly improved. No side effects occurred. Repeated catheterization after 6 months of continued oral therapy showed a sustained beneficial effect (Table I). The results in our patient clearly indicate that further evaluation of nifedipine use in primary pulmonary hypertension is warranted.