Atreya Auras R, Patel Mitkumar, Sivalingam Senthil K, Stoenescu Mathias L
University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA.
BMJ Case Rep. 2017 Jun 30;2017:bcr-2017-220604. doi: 10.1136/bcr-2017-220604.
A 67-year-old man with coronary artery disease (CAD) and left anterior descending artery (LAD) stent presented with symptomatic monomorphic ventricular tachycardia (VT) at a rate of 190 bpm requiring cardioversion. ECG showed left bundle branch block pattern and inferior axis, suggestive of a right ventricular outflow tract (RVOT) focus rather than left ventricular scar due to LAD territory myocardial infarction (MI). Echocardiography showed normal wall motion. Angiography revealed a patent mid-LAD stent. Cardiac MRI with delayed postcontrast sequence revealed several regions of hyperenhancement abnormality within the basal portion of the interventricular septum. Increased metabolic activity on positron emission tomography confirmed active inflammatory sarcoidosis.Although VTs in patients with prior CAD are likely to be related to either scar or ischaemia, alternative diagnoses (eg, infiltrative disorders, RVOT-VT, arrhythmogenic right ventricular cardiomyopathy) should be considered in patients with an apparent right ventricular focus on ECG.
一名67岁患有冠状动脉疾病（CAD）且左前降支动脉（LAD）置入支架的男性，出现症状性单形性室性心动过速（VT），心率为190次/分钟，需要进行心脏复律。心电图显示左束支传导阻滞图形及下轴，提示右心室流出道（RVOT）起源，而非由于LAD区域心肌梗死（MI）导致的左心室瘢痕。超声心动图显示室壁运动正常。血管造影显示LAD中段支架通畅。心脏磁共振成像延迟增强序列显示室间隔基底部有几个高增强异常区域。正电子发射断层扫描显示代谢活性增加，证实为活动性炎症性结节病。尽管既往有CAD的患者发生的VT可能与瘢痕或缺血有关，但对于心电图上明显提示右心室起源的患者，应考虑其他诊断（如浸润性疾病、RVOT-VT、致心律失常性右心室心肌病）。
