Clinical introduction A 52-year-old woman with shortness of breath and palpitations was referred to a cardiologist. A 24-hour Holter demonstrated high density (37%) of ventricular premature beats (VPBs) and long runs of non-sustained (eventually sustained) monomorphic ventricular tachycardia (VT) with the same morphology as several VPBs detected in a 12-lead ECG (figure 1A). A transthoracic echocardiogram was performed, and the patient’s evaluation was completed with a functional and gadolinium-enhanced cardiovascular MR (CMR) study (figure 1B,C) to assess structural heart disease. In a follow-up visit, an electrophysiological study (EPS) was performed to identify the origin of VPBs and VT (figure 1D).
Question What is the most likely cause of VPBs and VT?
Idiopathic VT in the absence of structural heart disease.
Bileaflet mitral valve prolapse (MVP).
Left ventricular non-compaction cardiomyopathy.
- ventricular tachycardia
- mitral regurgitation
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LF-F and JS contributed equally.
Contributors Conception and design of study, acquisition of data, analysis and/or interpretation of data, approval of the version of the manuscript to be published: AF, LF-F, JS. Drafting the manuscript: AF, LF-F. Revising the manuscript critically for important intellectual content: LF-F, JS.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.