Case 5

Abstract

A 51-year-old male patient with a past medical history of coronary artery disease, acute myocardial infarction at the age of 49 years, treated with PTCA and stent implantation at the level of the proximal LAD (Fig. 5.1), obstructive sleep apnea treated with CPAP, was addressed to the Cardiology Department for repeated episodes of palpitations with sudden onset, at rest, with a rapid and regular rhythm, accompanied by dyspnea and anxiety.

His cardiovascular risk factors were represented by active smoking, grade 3 obesity, and dyslipidemia. His medication at home consisted of aspirin 75 mg, verapamil SR 240 mg, perindopril 2 mg, atorvastatin 40 mg, esomeprazole 40 mg, and sertraline 200 mg.

At physical examination, his blood pressure was 117/81 mmHg, HR 74 bpm, SpO₂ 98% breathing room air, H = 173 cm, W = 125 kg, BMI = 41.76 kg/m², heart sounds were regular, there was a mild systolic murmur in the mitral auscultation region, lung auscultation was clear, there were mild bilateral edema of the lower limbs.

A smart heart rhythm monitor recorded a one-lead ECG during an episode of palpitations and established the diagnosis. An electrophysiological study was subsequently performed, which determined the nature of the tachycardia. A catheter ablation procedure was then successfully performed.