Coronary Artery Disease - STEMI Case #1 - Question #3 Answer

Four months later, he calls 911 due to sudden onset of weakness and pre-syncope. He is short of breath, diaphoretic and feels significant palpitations. He is afebrile with a blood pressure of 80/40 mm Hg, heart rate of 240 beats per minute, respirations 26 beats per minute and oxygen 88% on room air. His ECG is below:

MonomorphicVTach

Which of the following is the correct diagnosis?

A. Ventricular fibrillation

B. Monomorphic ventricular tachycardia

C. Polymorphic ventricular tachycardia

D. Wolff-Parkinson-White with pre-excitation and atrial fibrillation

 

See the Ventricular Tachycardia (VT) ECG Review for a complete summary.

The four main complications of a left ventricular aneurysm include the following:

  1. Ventricular tachycardia: The scar within the left ventricular aneurysm is a focus for ventricular arrhythmias which can lead to sudden cardiac death.
  2. Heart failure: The portion of the heart that contains the aneurysm is not contractile and is frequently “dyskinetic.” This results in overall decrease in heart function and the development of congestive heart failure.
  3. Left ventricular thrombus formation: When blood stagnates in any area of the body, there is a risk of platelet aggregation and thrombus formation. The aneurysmal portion of the LV is no different. Embolization of left ventricular thrombi can lead to embolic stroke or other systemic embolisms.
  4. Angina pectoris: The aneurysmal tissue can still cause symptoms of angina, even if revascularized.

There is a surgical procedure during which the surgeon resects the aneurysm and uses a Dacron patch. This is called the “Dor procedure” or the endoventricular circular patch plasty, or EVCPP. This procedure is indicated when medical therapy fails to control or acceptably improve the above mentioned complications/symptoms from the left ventricular aneurysm.