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

Iznenadna dugotrajna monomorfna ventrikularna tahikardija kod prethodno zdrave odrasle osobe sa puno uzroka za to, ali koji je pravi?

ARRHYTHMIA; VENTRICULAR tachycardia; ARRHYTHMOGENIC right ventricular dysplasia; CORONARY disease; MAGNETIC resonance imaging; MYOCARDIAL ischemia

Introduction. Sustained monomorphic ventricular tachycardia (VT) -- 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 deaths (SCD). The most common cause of VT 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 a 46-year-old man, a military officer, who experienced chest pain, palpitations, and nausea during regular physical activity at home. Due to the symptoms described, he was examined immediately and diagnosed with SMVT. Shortly after the diagnosis, he lost consciousness and was successfully resuscitated. A complete non-invasive and invasive cardiology examination was performed. It revealed that the patient had stable coronary disease and a muscle bridge on the left anterior descending artery. An ARVD was suspected after transthoracic echocardiography and heart magnetic resonance imaging. Genetic testing for ARVD was negative, but according to the Heart Rhythm Society expert consensus criteria, we had enough for a definitive diagnosis. The patient was hospitalized for ten days and treated with drugs without recurring VT or other disorders. We implanted an implantable loop recorder before the discharge and monitored the heart rhythm for one year. During a three-year follow-up, all of his electrocardiographic findings presented sinus rhythm without heart rhythm disorders. Conclusion. Sudden SMVT is the most common cause of SCD. 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. [ABSTRACT FROM AUTHOR]

Uvod. Dugotrajna monomorfna ventrikulska tahikardija (VT) -- DMVT je retka, nedovoljno dijagnostikovana patologija sa veoma lošom prognozom. Zajedno sa ventrikulskom fibrilacijom, DMVT je odgovorna za skoro sve iznenadne srčane smrti (ISS) nastale usled aritmije. Najčešći uzrok VT je ishemijska bolest srca, ali postoje i mnogi drugi razlozi, među kojima su aritmogena kardiomiopatija desne komore (AKDK) i fenomen miokardnog „mosta“ (bridge). Mogućnosti lečenja uključuju hibridni pristup, koji se sastoji od antiaritmijskih lekova, kateterske ablacije i implantabilnog kardioverter defibrilatora (IKD). Prikaz bolesnika. Prikazujemo slučaj 46-godišnjeg muškarca, oficira u vojsci, koji je tokom redovnih fizičkih aktivnosti kod kuće osetio bol u grudima, lupanje srca i mučninu. Zbog navedenih tegoba odmah je pregledan i dijagnostikovana mu je DMVT. Ubrzo nakon postavljanja dijagnoze bolesnik je izgubio svest i uspešno je reanimiran. Sprovedena je kompletna neinvazivna i invazivna kardiološka dijagnostika. Utvrđeno je da je bolesnik imao stabilnu koronarnu bolest i mišićni „most“ na prednjoj descedentnoj arteriji. Nakon transtorakalne ehokardiografije i magnetne rezonance srca, posumnjano je na AKDK. Genetsko testiranje na AKDK bilo je negativno, ali prema kriterijumima konsenzusa stručnjaka Heart Rhythm Society, imali smo dovoljno dokaza za definitivnu dijagnozu. Bolesnik je hospitalizovan tokom deset dana i lečen lekovima, bez pojave VT i drugih poremećaja. Pre otpusta iz bolnice, ugradili smo mu implantibilni loop rikorder i pratili srčani ritam tokom godinu dana. Tokom trogodišnjeg praćenja svi elektrokardiografski nalazi bili su normalni. Zaključak. Iznenadna DMVT je najčešći uzrok ISS. Detaljan pregled je od neprocenjive važnosti, kao i utvrđivanje neposrednog uzroka aritmije i primena odgovarajuće terapije, koja za te bolesnike predstavlja vid lečenja koji spasava život. Terapija uključuje lekove, elektrofiziologiju ili IKD ili kombinaciju ovih pristupa u lečenju. [ABSTRACT FROM AUTHOR]

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