Abstract
A 47-year-old woman experienced chest and back pain while working, and an ambulance was called. On admission, the heart rate was 101 beats per minute, blood pressure was 140/95 mmHg and consciousness was alert. Furthermore, she appeared pale, cold and perspired peripherally. ECG on admission showed elevations of ST segment in extensive leads: I, aVL, and V2 to V6. Immediately after the ECG examination, ECG monitoring showed ventricular fibrillation (VF). Following defibrillation, we felt pulsation of the carotid artery. The ECG monitoring record showed polymorphic ventricular tachycardia (PVT) following “R on T”. Urgent coronary angiography demonstrated 90% stenosis in the left anterior descending branch and simultaneous percutaneous coronary intervention was needed. As all ECG records during her clinical course showed a normal QT interval, it was suggested that PVT in this case was the type without prolonged QT interval. PVT with normal QT interval often occurs in the clinical course of coronary artery disease similar to that in this patient. It was also suggested that the PVT had shifted to VF within several tens of seconds. Accordingly, we must start cardio- pulmonary resuscitation in the emergency room. It was also suggested that there was a small residual ischemic lesion since PVT did not recur during her clinical course.
