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The cardiovascular system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Mary N Sheppard, C. Simon Herrington
Arrhythmogenic cardiomyopathy (AC) is an inherited heart-muscle disease that is a cause of sudden death in young people and athletes. It is characterized by progressive replacement of the right and left ventricle myocardium by either segmental or diffuse fibrofatty tissue, often from the epicardial surface inwards. Both ventricles are so frequently involved that the broader term ‘arrhythmogenic cardiomyopathy’ is now used, rather than the older term ‘arrhythmogenic right ventricular cardiomyopathy’. The fibrofatty replacement leads to ventricular arrhythmias. These arrhythmias may range from asymptomatic ventricular premature complexes to monomorphic ventricular tachycardia or ventricular fibrillation.
Perioperative Arrhythmias
Published in Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba, Acute Care Surgery and Trauma, 2016
Bipin K. Ravindran, Mohan N. Viswanathan
Ventricular tachyarrhythmias after noncardiac surgery are uncommon. In two series, the incidence is reported to be up to 3%; however, the vast majority of these included hemodynamically insignificant ectopic ventricular beats [46,47]. Although after cardiothoracic surgery, sustained monomorphic ventricular tachycardia (VT), polymorphic VT, and VF are seen in up to 1%–3% of patients [48,49]. In the same studies, not surprisingly, the presence of ventricular conduction disturbances was associated with a significantly worse outcome compared to similar patients who did not develop these arrhythmias.
Ventricular rhythms
Published in Andrew R Houghton, David Gray, Making Sense of the ECG, 2014
Ventricular rhythms are those which arise from the ventricles, i.e. below the level of the atrioventricular node. The ventricular rhythms we will consider are: ventricular ectopic beatsaccelerated idioventricular rhythmmonomorphic ventricular tachycardia (VT)polymorphic ventricular tachycardiaventricular fibrillation (VF).
Monomorphic ventricular tachycardia in a young female: look out for the zebras
Published in Acta Cardiologica, 2021
Abhinav Shrivastava, Jaskaran Singh Gujral, Ranjit Kumar Nath
A 22-year-old pregnant patient (32 weeks of gestation) presented to casualty with a history of syncope resulting in a fall. On examination, she was having tachycardia with hypotension. Electrocardiograph (ECG) (Figure 1, Panel A) revealed a broad QRS (≈160ms) tachycardia with monophasic and broad R wave with qR pattern in lead V1, R/S < 1 in lead V6 and a North-West axis with a positive R wave in aVR. All these features were suggestive of monomorphic ventricular tachycardia (MVT). Differential diagnoses included aetiologies like myocarditis, spontaneous coronary artery dissection, sarcoidosis, idiopathic left ventricular tachycardia (VT) (posterior fasicular type), and arrhythmic cardiomyopathy. She was immediately cardioverted with a 200 J synchronised biphasic shock, after which sinus rhythm was attained and the patient became hemodynamically stable. ECG after cardioversion (Figure 1, Panel B) showed a 3 mm ST-segment elevation in leads V1 with coving and inversion of T-waves, suggestive of Brugada type I pattern. The pattern persisted over several days of admission. Serial troponins were negative and the 2D transthoracic echocardiogram was normal. After the fall, there was an absence of foetal movements. The obstetric ultrasound revealed intrauterine foetal death, which was delivered vaginally. An autopsy was refused.
Abstracts from the Seventh Annual Baylor University Medical Center Medical Education Research Forum 2021
Published in Baylor University Medical Center Proceedings, 2021
Kashif Waqiee Ahmed, Thomas Cox, Jennifer Olvera, Natalie Gittus, Kirsten Ryan, Cristie Columbus
Monomorphic ventricular tachycardia (VT) has a broad differential. We present a case illustrating the importance of utilizing various imaging modalities for noninvasively eliciting the etiology of VT. A 55-year-old African American man presented to the emergency department for a postcoital monomorphic VT arrest requiring cardioversion. An electrocardiogram showed first-degree atrioventricular block, left anterior fascicular block, and right bundle branch block. A transthoracic echocardiogram showed a left ventricular ejection fraction of 50% with hypokinesis of the basal to mid anterior and anterolateral walls along with excessive right ventricular trabeculations. Cardiac catheterization showed normal coronaries. Cardiac magnetic resonance imaging revealed a diffuse epimyocardial scar along the basal and mid anterior, inferolateral, and anterolateral walls and a subendocardial scar along the basal and mid septum. The scar pattern suggested infiltrative disorders, inflammation, or rare dysplasia with fibrosis. No scar was seen in the right ventricle. Positron emission tomography revealed few small areas of mild fluorodeoxyglucose activity in the basilar to mid anterior wall, distal anterior wall near the apex, and basilar inferoseptal region. There was also evidence of old granulomatous disease in the liver. Given the classic electrocardiographic findings, clinical picture, and imaging findings, cardiac sarcoidosis was confirmed and steroids were initiated. Cardiac sarcoidosis as a cause of monomorphic VT remains an evasive diagnosis; a multimodality imaging strategy can help confirm the diagnosis.
A novel ECG criterion to differentiate left from right ventricular outflow tract premature complex
Published in Scandinavian Cardiovascular Journal, 2020
Mohammad Hossein Nikoo, Somayeh Taheri, Armin Attar
Idiopathic ventricular arrhythmias refers to ventricular arrhythmias defined in patients without structural heart disease or coronary artery disease [1]. These patients include 10% of the patients admitted to medical centers for detection of arrhythmia [2]. Idiopathic ventricular arrhythmia manifests itself mostly in the form of Premature ventricular complexes (PVC), repeated Non-sustained ventricular tachycardia (NSVT), and sometimes in the form of sustained monomorphic arrhythmia Monomorphic Ventricular Tachycardia (VT) [2]. Although outflow tract idiopathic tachycardia is among the benign arrhythmias, studies have shown that sudden death and tachycardia-induced cardiomyopathy are two significant complications that threaten these patients [3–5].