A 40 years old male diabetic with previous history of MI presented with dyspnea and chest pain

A 40 years old male diabetic with previous history of myocardial infarction and LVEF 35% presented with shortness of breath and chest pain. His functional capacity is poor due to underlying dyspnea on exertion. He was apprehensive, tachycardiac and maintaining his BP around 100/60 mmHg. ECG showed gross ST depression in precordial leads more than 2mm with non-progressive R waves. Trops were negative. Immediately on arrival to CCU he suddenly collapse and started gasping, monitor showed monomorphic VT with rate of 200bpm. He was resuscitated with 200Jshock and CPR for 5minutes. On revival, he was shifted to cath lab where coronary angiogram showed TVCAD

a)      What is the reason for monomorphic VT

b)      Would you consider ICD for this patient during his hospital stay

c)      What additional workup is indicated before surgery

d)      What is the mortality of CABG?

Answers:

a.      Scar VT

b.      Yes ICD is indicated because patient has EF <35% with recurrent angina

c.       Echocardiography, Carotid Doppler, Baseline CBC and creatinine, pulmonary function tests

d.      2 – 3%

References:

1. ACC/AHA/HRS 2008 Guidelines for device based therapy of cardiac rhythm abnormalities.
2. Hakeem A, Garg N.  Effectiveness of percutaneous coronary intervention with drug-eluting stents compared with bypass surgery in diabetics with multivessel coronary disease: comprehensive systematic review and meta-analysis of randomized clinical data.J Am Heart Assoc. 2013 Aug 7;2(4):e000354. doi: 10.1161/JAHA.113.000354.

Mechanism of scar VT will be discussed in a separate post.