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Case Reports
. 2021 Apr 21;14(4):e240549.
doi: 10.1136/bcr-2020-240549.

Calcified myocardial scar seen via cardiac imaging correlating with ventricular tachycardia focus

Zachary Zuzek  1 , Imran Rashid  2   3 , Ivan Cakulev  2   3 , Richard A Josephson  2   3
Affiliations
Case Reports

Calcified myocardial scar seen via cardiac imaging correlating with ventricular tachycardia focus

Zachary Zuzek et al. BMJ Case Rep. .

Abstract

A 74-year-old man presented with presyncope and non-sustained monomorphic ventricular tachycardia in the setting of acute coronary syndrome. On coronary angiogram, a calcified myocardial scar was revealed, which was later identified as the ventricular tachycardia focus via electrophysiological study.

Keywords: arrhythmias; ischaemic heart disease; pacing and electrophysiology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The12-lead ECG on admission. ECG demonstrating non-sustained monomorphic ventricular tachycardia (NSMVT) with positive concordance in the precordial leads and superior axis. Frequent premature ventricular contractions, often in couplets with identical morphology to the NSMVT, were also observed.
Figure 2
Figure 2
Coronary angiogram. right anterior oblique (RAO) caudal view highlighting diseased left circumflex artery (white arrowhead) and inferolateral calcifications (white arrows).
Figure 3
Figure 3
Cardiovascular MRI cine imaging (balanced steady state free precession) acquired in short axis (A) and three-chamber (C) views demonstrates regional thinning of the inferolateral wall with reduced signal intensity compared with remote myocardium (white arrows). Late gadolinium enhancement (LGE) imaging in short-axis (B) and three-chamber (D) views shows a region of avid transmural enhancement in the inferolateral wall indicative of myocardial infarction with discrete areas of low signal (red arrows). Low signal regions within areas of infarction on LGE imaging are indicative of either microvascular obstruction or dystrophic myocardial calcification, which can be differentiated by the acuity of the presentation. in this instance, the presence of a thin/remodelled inferolateral wall and modest troponin elevation are consistent with an existing transmural infarct with dystrophic myocardial calcification.
See this image and copyright information in PMC

References

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