Case history
Case history #1
A 65-year-old obese man presents with a crushing substernal chest pain for the past 3 hours and is hospitalised for an acute anterior wall myocardial infarction. His medical history includes hypertension and hyperlipidaemia. He is also a smoker. Primary angioplasty reveals an occluded right coronary artery, which is successfully stented. He is found to have a left ventricular function of 45% with reduced contractility (hypokinesis) of the inferior wall. On the third day of hospitalisation, telemetry reveals a 5-beat run of wide QRS complexes with a rate of 136 bpm. The patient is asymptomatic during this event.
Case history #2
A previously well 45-year-old man presents to the clinic with a 3-week history of progressive shortness of breath. He is able to perform activities of daily living independently but becomes short of breath with mild-to-moderate exertion. Echocardiogram reveals a reduced left ventricular ejection fraction of 30%. Cardiac catheterisation demonstrates normal coronary arteries. A 24-hour ambulatory ECG shows several episodes of NSVT.
Other presentations
NSVT is usually asymptomatic, although brief palpitations may sometimes be experienced. Symptoms in a patient with known NSVT are most often attributed to underlying cardiac disease rather than the arrhythmia itself. NSVT may present on a routine ECG or during a stress test being performed for other reasons.
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