Chest
Volume 99, Issue 5, May 1991, Pages 1295-1296
Journal home page for Chest

Laboratory and Animal Investigations
Exercise-Induced Ventricular Tachycardia in Association with a Myocardial Bridge

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Sustained ventricular tachycardia induced by exercise is uncommon. This is a report of a patient who has a positive exercise test at a high level of exercise. The electrocardiogram has classic ischemic ST depressions. Following the appearance of these ST depressions, the patient developed ventricular tachycardia at a rapid rate. Workup that included an echocardiogram and cardiac catheterization revealed myocardial bridging of the left anterior descending artery as the only structural abnormality. Electrophysiologic studies revealed the patient to have ventricular tachycardia only with isoproterenol (Isuprel) infusion. (Chest 1991; 99:1295-96)

Section snippets

CASE REPORT

A 41-year-old man presented with atypical chest discomfort. He is a nonhypertensive, nondiabetic who was referred for a stress test shortly after his mother underwent percutaneous transluminal coronary angioplasty (PTCA) of a tight proximal left anterior descending (LAD) artery lesion. The patient exercised to stage 5 of a Bruce protocol when significant flat ST depressions consistent with ischemia developed. A wide complex tachycardia then developed in the patient at a rate of 280 beats per

DISCUSSION

The congenital anomaly of a partial intramyocardial course of the LAD artery was first described by Crainicianu4 in 1922. Portsmann and Iwig5 first described systolic compression of a coronary artery on angiogram in 1960. In 1976, Noble et al6 described the physiologic effect of this anomaly. Severe systolic compression was shown to cause ischemia during rapid heart rates as myocardial lactate production, ST depressions, and angina were induced during atrial pacing.6 Shortly thereafter, there

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