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2017 ; 9
(7
): e1423
Nephropedia Template TP
Sundhu M
; Yildiz M
; Gul S
; Syed M
; Azher I
; Mosteller R
Cureus
2017[Jul]; 9
(7
): e1423
PMID28875096
show ga
Myocardial infarctions are frequently complicated by tachyarrhythmias, which
commonly have wide QRS complexes (QRS duration > 120 milliseconds). Many
published criteria exist to help differentiate between ventricular and
supraventricular mechanisms. We present a case of a 61-year-old male with a
history of hypertension, hyperlipidemia and coronary artery disease with prior
stenting of the right coronary artery (RCA). He had been noncompliant with his
antiplatelet medication and presented with cardiac arrest secondary to in-stent
thrombosis. He was resuscitated and his RCA was re-stented, after which he made a
good neurological recovery. During cardiac rehabilitation several weeks
post-intervention, he was noted to have sustained tachycardia with associated
nausea and lightheadedness, but no palpitation symptoms, chest pain or loss of
consciousness. He was sent to the emergency department, where his
electrocardiogram showed a tachycardia at 173 beats per minute which was regular,
with a relatively narrow QRS duration (maximum of 115-120 msec in leads I and
AVL) with a slurred QRS upstroke. This morphology was significantly different
from his QRS complex during sinus rhythm. Intravenous diltiazem was ineffective
but an amiodarone bolus terminated the tachycardia. The patient was admitted to
the coronary care unit and treated with intravenous amiodarone infusion. A
subsequent electrophysiology study was performed, showing inducibility of the
clinical tachycardia. Atrioventricular (AV) dissociation was present during the
induced arrhythmia, confirming the diagnosis of ventricular tachycardia. An
implantable cardiac defibrillator was placed and the patient was discharged.
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