A case of recurrent ventricular tachycardia

A 76 year old woman collapsed at home after feeling ill and faint, with central chest pain radiating to both arms. She was found to be in pulsatile ventricular tachycardia by paramedics and her arrhythmia was converted to sinus rhythm with 100 mg of intravenous lidocaine. Her medical history included an anteroapical myocardial infarction eight years previously and subsequent New York Heart Association class III heart failure with moderate to severe systolic dysfunction. Before this admission she had been maintained on lisinopril 20 mg once daily, isosorbide mononitrate 40 mg once daily, frusemide 40 mg twice daily, warfarin, atorvastatin 20 mg once daily, digoxin 250 µg once daily, carvedilol 6.25 mg once daily, and glyceryl trinitrate as needed. In the months before this episode she had experienced recurrent attacks of dizziness and palpitations and occasional episodes of anginal chest pain. Serial electrocardiographs showed sinus rhythm, QRS duration of 125 ms, septal Q waves, and non-dynamic 1 mm ST elevation unchanged from previous electrocardiographs. Cardiac enzymes were not raised. She had more episodes of ventricular tachycardia on the coronary care unit, however, and she underwent further treatment. Chest radiography (fig 1⇓) was performed before she was discharged.