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A young woman with known ventricular bigeminy presented with seizures. This case highlights the importance of considering cardiac causes, like catecholaminergic polymorphic ventricular tachycardia, in young patients with syncope and seizure-like episodes.

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Clinical Case Reports

Background:

  • Ventricular bigeminy is a known condition.
  • Sudden onset of convulsive episodes in a young, healthy individual can mimic seizures.
  • Differential diagnoses include cardiac syncope, neurogenic causes, and arrhythmias.

Observation:

  • Initial differential diagnoses included cardiac syncope with anoxic seizures or neurogenic arrhythmia due to subarachnoid hemorrhage.
  • Electrocardiograms (ECGs) revealed premature ventricular contractions (PVCs) with variable morphologies, including transient bidirectional beats.

Findings:

  • The ECG findings raised suspicion for catecholaminergic polymorphic ventricular tachycardia (CPVT).
  • The patient's medication, citalopram, was noted as part of her history.

Implications:

  • This case underscores the critical need for emergency clinicians to consider cardiac etiologies in young, otherwise healthy individuals presenting with syncope and seizure-like activity.
  • Early recognition of potential arrhythmias like CPVT is crucial for timely and appropriate management.
  • Highlights the importance of a thorough cardiac evaluation in unexplained syncope and seizure presentations.