Cargando…

Bidirectional Ventricular Tachycardia in Acute Multivessel Myocardial Infarction

Bidirectional ventricular tachycardia (BVT) is a rare and unusual ventricular dysrhythmia that is characterized by a beat-to-beat alternation of the QRS axis. This can sometimes manifest as alternating left and right bundle branch blocks. To the best of our knowledge, there are two previous cases of...

Descripción completa

Detalles Bibliográficos
Autores principales: Hsu, Frank, Goh, Justin, Jung, Andrew, Patel, Milan, Akel, Rami, Yamamura, Kenneth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9272731/
https://www.ncbi.nlm.nih.gov/pubmed/35832750
http://dx.doi.org/10.7759/cureus.25845
_version_ 1784744934596673536
author Hsu, Frank
Goh, Justin
Jung, Andrew
Patel, Milan
Akel, Rami
Yamamura, Kenneth
author_facet Hsu, Frank
Goh, Justin
Jung, Andrew
Patel, Milan
Akel, Rami
Yamamura, Kenneth
author_sort Hsu, Frank
collection PubMed
description Bidirectional ventricular tachycardia (BVT) is a rare and unusual ventricular dysrhythmia that is characterized by a beat-to-beat alternation of the QRS axis. This can sometimes manifest as alternating left and right bundle branch blocks. To the best of our knowledge, there are two previous cases of BVT in the setting of type I myocardial infarction. Our case would be the third and showed a subtle change in the anterior-posterior axis that can be seen in lead V2. The coronary angiography of our patient demonstrated severe multivessel coronary artery disease with complete total occlusion of the proximal dominant right coronary artery, 100% in-stent restenosis of the ostial left circumflex, 40% stenosis of left main, and 90% stenosis of mid left anterior descending artery (LAD). The BVT resolved after two amiodarone boluses followed by a drip. We attempted to transition to oral mexiletine, however, the patient was unable to tolerate the medication due to intractable nausea and vomiting. The patient subsequently underwent high risk coronary artery bypass graft surgery with no further episodes of BVT following revascularization and was discharged after six weeks of hospitalization. Although rare, type I myocardial infarction is an important differential diagnosis of BVT. 
format Online
Article
Text
id pubmed-9272731
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-92727312022-07-12 Bidirectional Ventricular Tachycardia in Acute Multivessel Myocardial Infarction Hsu, Frank Goh, Justin Jung, Andrew Patel, Milan Akel, Rami Yamamura, Kenneth Cureus Cardiology Bidirectional ventricular tachycardia (BVT) is a rare and unusual ventricular dysrhythmia that is characterized by a beat-to-beat alternation of the QRS axis. This can sometimes manifest as alternating left and right bundle branch blocks. To the best of our knowledge, there are two previous cases of BVT in the setting of type I myocardial infarction. Our case would be the third and showed a subtle change in the anterior-posterior axis that can be seen in lead V2. The coronary angiography of our patient demonstrated severe multivessel coronary artery disease with complete total occlusion of the proximal dominant right coronary artery, 100% in-stent restenosis of the ostial left circumflex, 40% stenosis of left main, and 90% stenosis of mid left anterior descending artery (LAD). The BVT resolved after two amiodarone boluses followed by a drip. We attempted to transition to oral mexiletine, however, the patient was unable to tolerate the medication due to intractable nausea and vomiting. The patient subsequently underwent high risk coronary artery bypass graft surgery with no further episodes of BVT following revascularization and was discharged after six weeks of hospitalization. Although rare, type I myocardial infarction is an important differential diagnosis of BVT.  Cureus 2022-06-11 /pmc/articles/PMC9272731/ /pubmed/35832750 http://dx.doi.org/10.7759/cureus.25845 Text en Copyright © 2022, Hsu et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Cardiology
Hsu, Frank
Goh, Justin
Jung, Andrew
Patel, Milan
Akel, Rami
Yamamura, Kenneth
Bidirectional Ventricular Tachycardia in Acute Multivessel Myocardial Infarction
title Bidirectional Ventricular Tachycardia in Acute Multivessel Myocardial Infarction
title_full Bidirectional Ventricular Tachycardia in Acute Multivessel Myocardial Infarction
title_fullStr Bidirectional Ventricular Tachycardia in Acute Multivessel Myocardial Infarction
title_full_unstemmed Bidirectional Ventricular Tachycardia in Acute Multivessel Myocardial Infarction
title_short Bidirectional Ventricular Tachycardia in Acute Multivessel Myocardial Infarction
title_sort bidirectional ventricular tachycardia in acute multivessel myocardial infarction
topic Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9272731/
https://www.ncbi.nlm.nih.gov/pubmed/35832750
http://dx.doi.org/10.7759/cureus.25845
work_keys_str_mv AT hsufrank bidirectionalventriculartachycardiainacutemultivesselmyocardialinfarction
AT gohjustin bidirectionalventriculartachycardiainacutemultivesselmyocardialinfarction
AT jungandrew bidirectionalventriculartachycardiainacutemultivesselmyocardialinfarction
AT patelmilan bidirectionalventriculartachycardiainacutemultivesselmyocardialinfarction
AT akelrami bidirectionalventriculartachycardiainacutemultivesselmyocardialinfarction
AT yamamurakenneth bidirectionalventriculartachycardiainacutemultivesselmyocardialinfarction