Dear Editor,
Polymorphic ventricular tachycardia (PVT) is a potentially fatal arrhythmia that typically affects patients with structural heart problems. Monomorphic and PVT are two types of ventricular tachycardia (VT). Monomorphic tachycardia occurs when the QRS complex represents the depolarization of ventricles remain the same from beat to beat, indicating persistent tachycardia originating from a focus or a structural substrate.[1] We reported 26 years old male with no significant medical history who was admitted to the primary health center emergency department after presenting with syncope while working on the farm. When the patient arrived at the emergency department, he regained consciousness but was lethargic, diaphoretic, and tachypneic. The patient was in hypotension, and their pulse was tachycardic. The patient’s extremities were cold on examination, and the electrocardiogram showed a sustained PVT at 298/min [Figure 1]. The patient was given a 300 mg bolus of injection (Inj). Cordarone. But the patient succumbed within 30 min after arriving at the emergency room.
Figure 1.
Electrocardiograph shows PVT
A previous infarct is the most prevalent cause of the scar. The authors did not have any prior electrocardiogram data that could reveal the primary cause of VT in the present case. The patient described here was young without any significant medical history, but VT can also occur without structural heart disease.[2] Although there has been a rise in the incidences of cardiac disease in India, the diagnostic and therapeutic facilities required to treat this disease are generally insufficient, making emergency treatment challenging.[3]
Lidocaine is another option. Because procainamide can worsen heart failure, amiodarone is chosen for pharmacologic conversion if left ventricular function is poor. Nevertheless, the currently available evidence in the literature shows that Cordarone should not be the drug of choice as the first-line antiarrhythmic regimen for stable VT. The medication gradually affects myocardial conduction and refractoriness.[3] The novelty of this case is a cardiac disease can be caused at any age, but it can be prevented at the primary health center with the availability of life-saving equipment.
Key Point: Cardiac disease among the elderly is ubiquitous, but it is rare and the burden of the disease is on young adults. Essential equipment unavailability at the primary health center is the cause of the death.
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References
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