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BMJ Case Rep. 2009; 2009: bcr10.2008.1168.
Published online 2009 March 17. doi:  10.1136/bcr.10.2008.1168
PMCID: PMC3027544
Reminder of important clinical lesson

Polymorphic ventricular tachycardia during a stress test


A 70-year-old man with a history of morbid obesity, atrial fibrillation, hypertension, hypercholesterolaemia and type II diabetes mellitus was undergoing a dobutamine stress echocardiogram for the evaluation of chest pain. At an infusion rate of 30 μg/kg per min the patient experienced sudden haemodynamically unstable polymorphic ventricular tachycardia and was immediately cardioverted to sinus rhythm with one monophasic 200 J d.c. shock. Subsequent coronary catheterisation showed non-obstructive coronary disease and moderate global hypokinesis with an ejection fraction of 35%. An automated cardioverter defibrillator was implanted; interrogation of the device at 1 month follow-up revealed no episodes of ventricular tachycardia.

Figure 1
Lead II rhythm strip during initiation of polymorphic ventricular tachycardia.


Competing interests: none.

Patient consent: Patient/guardian consent was obtained for publication.

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