Kio

Ischemic Cardiomyopathy

Fig. 3. Examples of NSVT:

(A) Monomorphic NSVT in a patient with ischemic cardiomyopathy. The patient fit the MADIT/ MUSTT profile. During EPS, rapid VT was induced, and the patient received an ICD.

(B) Monomorphic NSVT in a patient with underlying nonischemic cardiomyopathy and AF. Note that the PVC that initiates NSVT has a different morphology than the subsequent salvo of NSVT.

(C) Torsades de pointes PVT in a patient with acquired LQTS caused by quinidine therapy. Note the recurrent paroxysms of NSVT following "long-short" sequences.

Fig. 3. Examples of NSVT:

(A) Monomorphic NSVT in a patient with ischemic cardiomyopathy. The patient fit the MADIT/ MUSTT profile. During EPS, rapid VT was induced, and the patient received an ICD.

(B) Monomorphic NSVT in a patient with underlying nonischemic cardiomyopathy and AF. Note that the PVC that initiates NSVT has a different morphology than the subsequent salvo of NSVT.

(C) Torsades de pointes PVT in a patient with acquired LQTS caused by quinidine therapy. Note the recurrent paroxysms of NSVT following "long-short" sequences.

Polymorphic

Fig. 3. (Continued) Examples of NSVT:

(D) Polymorphic NSVT in a patient with acute MI. Although the morphology is suggestive of torsades, marked QT prolongation is absent. The etiology was believed to be acute ischemia.

(E) Pause-dependent torsades de pointes, in a patient with atrial flutter treated with iv procainamide and verapamil.

(F) Incessant nonsustained torsades de pointes VT, in a patient early after mitral-valve surgery. Atrial overdrive pacing suppressed further episodes.

(G) Incessant nonsustained polymorphic VT in a patient with nonischemic cardiomyopathy. Acutely, the VT was suppressed by IV amiodarone, and the patient received an ICD.

Fig. 3. (Continued) Examples of NSVT:

(D) Polymorphic NSVT in a patient with acute MI. Although the morphology is suggestive of torsades, marked QT prolongation is absent. The etiology was believed to be acute ischemia.

(E) Pause-dependent torsades de pointes, in a patient with atrial flutter treated with iv procainamide and verapamil.

(F) Incessant nonsustained torsades de pointes VT, in a patient early after mitral-valve surgery. Atrial overdrive pacing suppressed further episodes.

(G) Incessant nonsustained polymorphic VT in a patient with nonischemic cardiomyopathy. Acutely, the VT was suppressed by IV amiodarone, and the patient received an ICD.

Atrial Flutter Overdrive Pacing

Fig. 3. (Continued) Examples of NSVT:

(H) Spontaneous recording in an 11-yr-old female with syncope and "probable" hypertrophic cardiomyopathy. She received an ICD, and has had no recurrent syncope or ICD discharges during 10 yr of follow-up.

(I) Young athlete with palpitations during exercise. Work-up was negative for structural heart disease. During a treadmill exercise test, this rhythm was recorded. VT seemed to be triggered by sinus rates above 160 BPM. The patient was treated with a beta-blocker, and was unable to achieve this sinus rate. He has done well, without symptomatic VT recurrences.

(J) Young athlete with palpitations and syncope, which occurred while playing hockey. No structrual heart disease was detected during a thorough evaluation. Two rates of tachycardia were recorded (top and bottom panels). Diagnostic EPS was unrevealing. Though this appears monomorphic, simultaneous recording in multiple leads revealed polymorphic VT. The patient was treated with a beta-blocker, and no recurrences were observed during follow-up.

Was this article helpful?

0 0
Your Heart and Nutrition

Your Heart and Nutrition

Prevention is better than a cure. Learn how to cherish your heart by taking the necessary means to keep it pumping healthily and steadily through your life.

Get My Free Ebook


Post a comment