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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2022
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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 |
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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 |
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