A 52-year-old woman with ventricular tachycardia

Heart. 2018 Dec;104(24):2025-2043. doi: 10.1136/heartjnl-2018-313347. Epub 2018 Sep 4.


Clinical introduction: A 52-year-old woman with shortness of breath and palpitations was referred to a cardiologist. A 24-hour Holter demonstrated high density (37%) of ventricular premature beats (VPBs) and long runs of non-sustained (eventually sustained) monomorphic ventricular tachycardia (VT) with the same morphology as several VPBs detected in a 12-lead ECG (figure 1A). A transthoracic echocardiogram was performed, and the patient's evaluation was completed with a functional and gadolinium-enhanced cardiovascular MR (CMR) study (figure 1B,C) to assess structural heart disease. In a follow-up visit, an electrophysiological study (EPS) was performed to identify the origin of VPBs and VT (figure 1D).heartjnl;104/24/2025/F1F1F1Figure 1(A) A 12-lead ECG. (B) Cine CMR-SSFP (steady-state-free-precession) sequence on a three-chamber view. (C) Inversion-recovery gradient echo CMR pulse sequence for delayed enhancement assessment. (D) Three-dimensional electroanatomic voltage mapping of the left ventricular cavity (cranial left anterior oblique view). CMR, cardiovascular MR.

Question: What is the most likely cause of VPBs and VT?Idiopathic VT in the absence of structural heart disease.Bileaflet mitral valve prolapse (MVP).Dilated cardiomyopathy.Left ventricular non-compaction cardiomyopathy.Ischaemic cardiomyopathy.

Keywords: mitral regurgitation; ventricular tachycardia.

Publication types

  • Case Reports

MeSH terms

  • Diagnosis, Differential
  • Echocardiography
  • Electrocardiography*
  • Female
  • Heart Rate / physiology*
  • Humans
  • Magnetic Resonance Imaging, Cine / methods*
  • Middle Aged
  • Mitral Valve Prolapse / complications*
  • Mitral Valve Prolapse / diagnosis
  • Tachycardia, Ventricular / diagnosis
  • Tachycardia, Ventricular / etiology*