Idioventricular tachycardia with angina pectoris.

Area of Science:

• Cardiology
• Electrophysiology
• Internal Medicine

Background:

• Idioventricular tachycardia (IVT) is a ventricular arrhythmia typically associated with acute myocardial infarction.
• IVT is rarely observed in the context of stable angina or during exercise testing.
• Previous literature does not extensively document IVT precipitated by stress-induced angina.

Purpose of the Study:

• To report a unique case of recurrent idioventricular tachycardia triggered by stress-induced angina.
• To investigate the relationship between angina pectoris, exercise, and ventricular arrhythmias.
• To highlight an unusual presentation of IVT in a patient with significant coronary artery disease.

Main Methods:

• Case report detailing a patient experiencing recurrent episodes of IVT.
• Diagnostic procedures included His bundle electrograms and cardiac catheterization.
• Correlation of IVT episodes with specific stress-induced angina events, including exercise tests and pacing-induced tachycardia.

Main Results:

• Idioventricular tachycardia occurred on three separate occasions, consistently linked to stress-induced angina.
• Episodes followed a Master's test, a treadmill exercise test, and paroxysmal atrial tachycardia from endocardial pacing.
• His bundle electrograms confirmed the ventricular origin of the tachycardia; cardiac catheterization revealed severe coronary artery disease.

Conclusions:

• This case represents the first reported instance of idioventricular tachycardia repeatedly induced by stress-induced angina.
• The findings suggest a potential link between severe coronary artery disease, angina exacerbations, and ventricular arrhythmias.
• Further investigation may be warranted to understand the mechanisms underlying exercise- and stress-induced IVT in specific patient populations.