PMC9072029_01
Initial EKG, before cardioversion, showing SMVT. 159 BPM, PR interval 38 ms, QRS duration 188 ms, QT/QTc 322/523 ms.
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Sustained monomorphic ventricular tachycardia (SMVT) was noted on her initial EKG (Figure 1), and soon after, the patient appeared diaphoretic and ill with increasing complaints of lightheadedness and palpitations.
EKG status post cardioversion demonstrating ST elevations in II, III, and AVF. T-wave inversions noted in V3, V4, V5, and V6. 52 BPM, PR interval 106 ms, QRS duration 80 ms, QT/QTc 458/425 ms.
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An EKG postcardioversion was conducted that demonstrated likely inferior STEMI (Figure 2).
The left main and LAD arteries are diffusely dilated and tortuous, ending in a coronary aneurysm with a fistulous connection to the right ventricular apex. The left anterior descending artery measures 13 mm proximally with a giant aneurysm measuring 21 mm as it fistulizes to the RV apex.
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Left heart catheterization (Figure 3) showed the left main, and LAD arteries were diffusely dilated and tortuous, ending in a coronary aneurysm with a fistulous connection to the right ventricular apex.