Abstract
A 57 year old man was admitted for investigation of recurrent syncopal attacks. Holter monitoring during an attack while in hospital revealed a unique sequence of gross ST segment elevation, ventricular tachycardia, prolonged ventricular fibrillation, asystole, junctional and ventricular escape rhythm, and finally spontaneous restoration of sinus rhythm with severe ST segment depression. Subsequent coronary arteriography demonstrated severe stenoses of the right coronary artery, prompting percutaneous transluminal angioplasty and stenting. The patient has had no further syncopal attacks. Keywords: ventricular fibrillation; Holter monitoring; coronary stenoses; silent ischaemia; arrhythmias
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Figure 1 .
24 hour Holter monitor recording showing (A) onset of severe ST segment elevation; (B) ventricular tachycardia; (C) ventricular fibrillation; (D) ventricular asystole; (E) junctional and ventricular escape rhythm; and (F) sinus rhythm.
Figure 2 .
Left: Angiogram showing stenoses of the right coronary artery. Right: Same coronary artery after stenting.