case_images: PMC9072029_01
case_images: Initial EKG, before cardioversion, showing SMVT. 159 BPM, PR interval 38 ms, QRS duration 188 ms, QT/QTc 322/523 ms.
case_images: CRIC2022-7700086.001.jpg
case_images: PMC9072029_01_CRIC2022-7700086.001.jpg
case_images: fig1
case_images: Sustained monomorphic ventricular tachycardia (SMVT) was noted on her initial EKG (Figure 1), and soon after, the patient appeared diaphoretic and ill with increasing complaints of lightheadedness and palpitations.
case_images: EKG status post cardioversion demonstrating ST elevations in II, III, and AVF. T-wave inversions noted in V3, V4, V5, and V6. 52 BPM, PR interval 106 ms, QRS duration 80 ms, QT/QTc 458/425 ms.
case_images: CRIC2022-7700086.002.jpg
case_images: PMC9072029_01_CRIC2022-7700086.002.jpg
case_images: fig2
case_images: An EKG postcardioversion was conducted that demonstrated likely inferior STEMI (Figure 2).
case_images: The left main and LAD arteries are diffusely dilated and tortuous, ending in a coronary aneurysm with a fistulous connection to the right ventricular apex. The left anterior descending artery measures 13 mm proximally with a giant aneurysm measuring 21 mm as it fistulizes to the RV apex.
case_images: CRIC2022-7700086.003.jpg
case_images: PMC9072029_01_CRIC2022-7700086.003.jpg
case_images: fig3
case_images: Left heart catheterization (Figure 3) showed the left main, and LAD arteries were diffusely dilated and tortuous, ending in a coronary aneurysm with a fistulous connection to the right ventricular apex.