PMC7063638_01
(A) Electrocardiogram (ECG) on admission showing old septal Q waves. (B) ECG obtained after polymorphic ventricular tachycardia (PMVT). Q waves are more prominently seen in V1-V3, with occasional premature ventricular contraction. (C) PMVT observed on telemetry. (D) Day 3 ECG. Dynamic T-wave inversions in precordial leads.
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On initial assessment in hospital, her electrocardiogram (ECG) was remarkable for pathologic Q waves present in V1 and V2, with a normal QTc of 429 ms (Fig. 1A). During the early hours of the morning, she developed a short salvo of polymorphic ventricular tachycardia (PMVT) that lasted approximately 8 seconds, along with multiple premature ventricular complexes while asleep (Fig. 1C). Her troponin was markedly elevated at 1307 ng/L with an ECG that was performed shortly after the event showing extension of the preexisting Q waves in the precordial leads now to V3 (Fig. 1B). A repeat ECG on day 3 showed T-wave inversions in the precordial leads and a slightly prolonged QTc of 481 ms (Fig. 1D).
Left ventricular angiogram in (A) end diastole, (B) mid systole, and (C) end systole.
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Left ventricular angiography demonstrated preserved movement of the base and the apical cap of the left ventricle, but with midventricular wall hypokinesis and a left ventricular ejection fraction (LVEF) of 43% (Fig. 2).