Sudden sustained monomorphic ventricular tachycardia in a previously healthy adult with many causes for it, but which one is the correct? A case report

Abstract

Introduction. Sustained monomorphic ventricular tachycardia (SMVT) is a rare, underdiagnosed pathology, with a very poor prognosis. Along with ventricular fibrillation, SMVT is responsible for nearly all of the arrhythmic sudden cardiac death (SCD). The most common cause of ventricular tachycardia is ischemic heart disease, but there are many other reasons, among which are: arrhythmogenic right ventricular cardiomyopathy (ARVD) and myocardial bridging phenomenon. Treatment options include a hybrid approach consisting of antiarrhythmic drugs, catheter ablation and implantable cardioverter defibrillators (ICD). Case report. We present a case of 46-year old man, military officer, who experienced chest pain, palpitations and nausea during regularly physical activity at home. Due to the symptoms described, he examined immediately and diagnosed sustained monomorphic ventricular tachycardia. Shortly after the diagnosis, he lost consciousness, and successfully resuscitated. A complete non-invasive and invasive cardiology examination performed and it revealed that the patient had stable coronary disease, a muscle bridge on the LAD, and arrhythmogenic right ventricular cardiomyopathy suspected after transthoracic echocardiography and heart MRI. Genetic testing for ARVD was negative, but according to the Heart Rhythm Society (HRS) expert consensus criteria, we had enough for a definitive diagnosis. Conclusion. SMVT is the most common cause of sudden cardiac death. It is of inestimable importance to carry out a detailed examination and determine the immediate cause of the arrhythmia and the right therapy, which for these patients is a life-saving form of treatment. Therapy includes medications, electrophysiology, or ICD, or a combination of these treatment approaches.