A 40 years old male diabetic with previous history of MI presented with dyspnea and chest pain

A 40 years old male diabetic with previous history of myocardial infarction and LVEF 35% presented with shortness of breath and chest pain. His functional capacity is poor due to underlying dyspnea on exertion. He was apprehensive, tachycardiac and maintaining his BP around 100/60 mmHg. ECG showed gross ST depression in precordial leads more than 2mm with non-progressive R waves. Trops were negative. Immediately on arrival to CCU he suddenly collapse and started gasping, monitor showed monomorphic VT with rate of 200bpm. He was resuscitated with 200Jshock and CPR for 5minutes. On revival, he was shifted to cath lab where coronary angiogram showed TVCAD

a) What is the reason for monomorphic VT

b) Would you consider ICD for this patient during his hospital stay

c) What additional workup is indicated before surgery

d) What is the mortality of CABG?

Answers:

a. Scar VT

b. Yes ICD is indicated because patient has EF <35% with recurrent angina

c. Echocardiography, Carotid Doppler, Baseline CBC and creatinine, pulmonary function tests

d. 2 – 3%

References:

ACC/AHA/HRS 2008 Guidelines for device based therapy of cardiac rhythm abnormalities.
Hakeem A, Garg N. Effectiveness of percutaneous coronary intervention with drug-eluting stents compared with bypass surgery in diabetics with multivessel coronary disease: comprehensive systematic review and meta-analysis of randomized clinical data.J Am Heart Assoc. 2013 Aug 7;2(4):e000354. doi: 10.1161/JAHA.113.000354.

Mechanism of scar VT will be discussed in a separate post.

Comments

Approach to Supraventricular Tachycardia - SVT

I would like to share with you about SVTs, or supraventricular tachycardia, today. I'll be focusing on the pathophysiology, ECG features, and the management of SVT today. So this is a brief outline of the lecture today. I will be going through the definition of SVTs, followed by a brief classification of tachyarrhythmias, the pathophysiology behind it all, ECG features, and management principles of SVTs. I will round off the lecture with a clinical scenario related to the topic. This lecture is meant to be a basic introduction to SVTs, and is by all means not exhaustive. So without further ado, let us begin. Supraventricular tachycardias are defined as narrow complex tachycardias where the point of stimulation arises from above the bundle branches. There are many types of SVTs, as will be shown in the next slide, and some are more common than the others. However, in our local context, it is used interchangeably with proximal supraventricular tachycardias, which make up...

Learn Echocardiography | Standard Protocol for Performing Comprehensive Echocardiogram | Explained with Images and Videos

If you are just starting to learn echocardiography, you will find that learning the full echo examination protocol will be immensely useful. The full protocol will provide a solid foundation for your career in echo. I personally found that once I could execute the standard protocol flawlessly, I was able to add and refine additional echo scanning skills while deepening my understanding of the purpose of each echo image. The echo protocol illustrated in this article is the same one we currently use for all our patients in the hospital and meets or exceeds the standards of American Society of Echocardiography (ASE) for an adult echocardiography examination. The protocol presented here is meant as a guideline and does not cover every aspect (such as off axis views) of an echo examination. Also other hospitals will probably have slight variations of this protocol depending on the lab's needs, which is normal. This article's main purpose is to provide a solid foundation for ...

What is Duke treadmill Score (DTS) and How to calculate it?

Watch this simple video on DTS calculation with example case: Commonly asked questions: How to Calculate Duke treadmill Score? What is DTS? How to risk stratify a patient with ETT (Exercise Tolerance Test)? #Cardiology #Non-Invasive risk Stratification

Dr. Usman's Cardiology Notes

Search This Blog