A Case of Successful Medical Treatment of Ventricular Tachycardia in a Patient With Ischemic Heart Disease and Heart Failure

Abstract

The pathogenetic mechanisms of arrhythmias, including  high-grade ventricular  arrhythmias (including non-sustained ventricular  tachycardia),  in patients with coronary  heart disease may be different. Therefore, the characteristics  of ventricular arrhythmias must be considered  based on the totality of data, taking  into account all the available features. The importance  of a personalized approach  to the management of a patient with coronary  heart disease who had extensive myocardial  infarction 18.5 years ago,  followed  by mammary  coronary  artery bypass  grafting, aneurysmectomy and the development of heart failure with a low ejection fraction, in whom ventricular arrhythmias occurred against the background of a stable course of coronary disease , but after emotional stress, is reflected in this work. An extended examination, as well as a detailed study of the nature of ventricular arrhythmias, made it possible  to determine  the main provoking factor and select an individualized pathogenetic treatment with a good  antiarrhythmic result that persists for several years of observation.  Conducting mental tests and psychological questioning can be recommended for patients with coronary  heart disease  and  chronic  heart failure as an additional  examination to assess  the contribution  of the psycho-emotional factor  to arrhythmogenesis after excluding the ischemic and sympathetic  nature of ventricular ectopia. It is incorrect to consider that all ventricular arrhythmias  in patients with coronary heart disease are ischemic in nature, and in some clinical situations this statement is even erroneous.