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The Heavy Heart: An Unusual Cause of Ventricular Tachycardia

  • Author Footnotes
    1 Authorship: Co-first authors/equal contributions. All authors had access to the data and a role in writing this manuscript. NZ: Conceptualization, Writing - original draft; JL: Conceptualization, Writing - review & editing; TL: Supervision, Funding acquisition; BC: Supervision.
    Nan Zhang
    Footnotes
    1 Authorship: Co-first authors/equal contributions. All authors had access to the data and a role in writing this manuscript. NZ: Conceptualization, Writing - original draft; JL: Conceptualization, Writing - review & editing; TL: Supervision, Funding acquisition; BC: Supervision.
    Affiliations
    Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
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  • Author Footnotes
    1 Authorship: Co-first authors/equal contributions. All authors had access to the data and a role in writing this manuscript. NZ: Conceptualization, Writing - original draft; JL: Conceptualization, Writing - review & editing; TL: Supervision, Funding acquisition; BC: Supervision.
    Jian Liu
    Footnotes
    1 Authorship: Co-first authors/equal contributions. All authors had access to the data and a role in writing this manuscript. NZ: Conceptualization, Writing - original draft; JL: Conceptualization, Writing - review & editing; TL: Supervision, Funding acquisition; BC: Supervision.
    Affiliations
    Intensive Care Unit, Second Hospital of Tianjin Medical University, Tianjin, China
    Search for articles by this author
  • Tong Liu
    Correspondence
    Requests for reprints should be addressed to Tong Liu, MD, PhD, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Hexi District, Tianjin 300211, People’s Republic of China.
    Affiliations
    Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
    Search for articles by this author
  • Bing Chen
    Correspondence
    Requests for reprints should be addressed to Bing Chen, MD, Intensive Care Unit, Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Hexi District, Tianjin 300211, People’s Republic of China.
    Affiliations
    Intensive Care Unit, Second Hospital of Tianjin Medical University, Tianjin, China
    Search for articles by this author
  • Author Footnotes
    1 Authorship: Co-first authors/equal contributions. All authors had access to the data and a role in writing this manuscript. NZ: Conceptualization, Writing - original draft; JL: Conceptualization, Writing - review & editing; TL: Supervision, Funding acquisition; BC: Supervision.
Published:December 07, 2022DOI:https://doi.org/10.1016/j.amjmed.2022.10.022
      A 17-year-old young woman presented to the Emergency Department with a 1-hour history of abdominal pain, nausea, vomiting, and weakness. Physical examination on admission revealed a heart rate of 106 beats per minute, blood pressure of 136/88 mm Hg, and a respiratory rate of 25 breaths per minute. Her medical history was unremarkable with no prior medical comorbidities or surgical history. She denied taking any prescribed or over-the-counter medications. The initial electrocardiogram (ECG) showed ventricular tachycardia (VT) (Figure 1), with investigations revealing a normal troponin I level of <0.03 ng/mL (reference range <0.3 ng/mL), elevated N-terminal pro-brain natriuretic peptide level of 439.2 ng/L (reference range <300 ng/L), and normal serum potassium level of 4.0 mmol/L (reference range 3.5-5.3 mmol/L). Over the next hours, the patient developed shallow respirations, with rapid worsening of muscle weakness involving all 4 limbs. An arterial blood gas obtained on room air revealed severe acidosis (pH, 7.178) and hypoxemia (PaO2, 65.8 mm Hg). A repeated blood test conducted 4 hours after admission noted profound hypokalemia (serum potassium, 1.9 mmol/L).
      Figure 1
      Figure 1Electrocardiogram (ECG) at admission. The admission ECG revealed a wide complex tachycardia at a rate of 106 beats per minute, a QRS duration of 200 ms, an initial dominant R wave in aVR, a fusion complex in the 7th beat, northwest axis deviation, positive monophasic QRS complexes in V1, and an R/S ratio <1 in V6, which suggested a diagnosis of ventricular tachycardia, probably originating from the free wall of the left ventricle.
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