[SCD-FORUM] 82E RE: Case: Male, 29yrs. Dr. Fontaine to Dr. Zhu

[SCD Symposium]

Dear Dr Zhu

Interesting case. In such a case it is important what is the probable  
site of origin of VT ? Is the VT always of the same morphology ?

If VT originates in the left ventricle it is probably the result of  
myocarditis
If VT originates in the RV it is probably a case of ARVD or IDCM with  
preserved cardiac function.

Therefore it is also important to have a better description of the  
clinical expression of myocarditis. How severe it was?

It is also important to know if regular echo showed a decrease in  
cardiac function.

Guy Fontaine MD PhD

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee

>
> Case: Male, 29yrs
>
> Illness history: Viral myocarditis was diagnosed based on premature  
> ventricular contractions (PVCs) at age 8 after an influenza attack.  
> Since then, PVBs never disappeared and right ventricle enlargement  
> had been noticed.
>
> ECG revealed VT lasting 3 minutes at age 19, accompanied with  
> faintness. After 2-3 years, no VT reoccurred.
>
> The second VT episode was recorded at age 21 lasting 2-3 hrs  
> accompanied with syncope. Intravenous propafenon worked. Oral  
> administration of propafenon could not prevent the patient from VT  
> attack.
>
> RFCA for VT had been delivered twice at age 22~23 by Pro. Yang at  
> the first affiliated Hospital of Dalian medical university. During  
> RFCA, VT could not be induced and cardiomyopathy was diagnosed by  
> endocardiac biopsy.
>
>
> VTs occurred intermediately lasting several seconds to a few  
> minutes. VT restored to sinuous rhythm either spontaneously or by  
> intravenous propafenon administration. VT usually occurred at  
> midnight or early morning. At the following years, Sometimes VT  
> occurred quite often during a certain period (for example: twice  
> attacks in Winter), and then no occurrence for several months or  
> even longer time. The patient enjoys doing exercise. No VT attacked  
> during exercise. No restriction to exercise.
>
> Since 27 yrs old (2004), propafenon has been administrated in the  
> doses of 150mg bid or tid. Drug quitted after 1-2 months  
> administrations, keeping no VT attack for 0.5-1.5 yrs.
> Since last year, the drug cannot be quitted, otherwise VT  
> reoccurred. So far, the doses of the drug are 200mg at early  
> morning and 150mg at night. Lower dosages may not prevent the VTs.
>
> Any suggestion about the treatment?
>
> Zhu <dyeyxnk at yahoo.com.cn>

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