Am Heart Hosp J. 2010;8(2):115–117


Lozenge Reference


Case Report


Tachycardia-induced Cardiomyopathy— A Fully Reversible Phenomenon


Michael CY Nam, MD,1 Nigel Brown, MD1


Adarsh Aravind, MD,1 Koo Chan, MD,1 Simon James, MD2 and


Tachycardia induced cardiomyopathy (TIC) is a rare but potentially reversible cause of heart failure. The case of a patient with severe tachycardiomyopathy who had a favorable outcome following treatment of tachyarrythmia is presented here.


H


eart failure is one of the commonest reasons for hospital admission. Its etiology, which may not always be apparent on initial assessment, has important prognostic implications. Tachycardia-induced cardiomyopathy (TIC) is rare in the adult population— only one case was encountered in two observational studies involving nearly 2,000 patients with unexplained dilated cardiomyopathy—but is potentially curable and should therefore be considered in all patients with heart failure and tachhyarrythmias.1,2


presenting with a broad complex tachycardia and severe heart failure in which significant restoration of cardiac function was obtained within six weeks of resolving her tachycardia.


Case Study


A previously fit and well 50-year-old teacher presented with a two-week history of dyspnea on exertion. She denied any chest pain, palpitations, or recent flu-like illnesses. There was no family history of cardiac disease or sudden death and she was non-smoker with minimal alcohol intake.


On admission the patient had clinical and radiologic signs of severe heart failure. Her electrocardiogram (ECG) showed a regular broad complex tachycardia with left bundle branch block (LBBB) morphology and a ventricular rate of 215bpm (see Figure 1). She was given 6mg of intravenous adenosine which reverted her to sinus rhythm (SR). An ECG performed at this point (see Figure 2A) showed


the presence of delta waves and a shortened PR interval, in keeping with a diagnosis of Wolff-Parkinson-White (WPW) syndrome. There was also T wave inversion (TWI) in the anterolateral leads.


We describe a patient


The patient was treated with intravenous furosemide, ramipril, and bisoprolol for her heart failure. Anti-thrombotic therapy was initiated for presumed acute coronary syndrome but this was stopped when serial troponin I measurements reverted to normal. The ECG performed shortly after admission in SR revealed non-dilated ventricles but moderate-to-severe global biventricular dysfunction with an estimated left ventricular ejection fraction (LVEF) of around 15–20%. There was mild secondary mitral and tricuspid regurgitation.


The differential for her admission ECG in tachycardia includes ventricular tachycardia, pre-excited supraventricular tachycardia (SVT), or SVT with aberrant conduction. There were P waves identified with a 1:1 ventriculo–atrial association, suggesting SVT. The RP interval was >50% of the RR interval, making this a long RP tachycardia. The differential for a long RP tachycardia includes atrial tachycardia, atypical atrioventricular nodal re-entrant tachycardia (AVNRT—fast–slow variant), antidromic atrioventricular re-entrant tachycardia (AVRT—pre-excited SVT), or orthodromic AVRT with a slowly conducting accessory pathway.


• 1. Royal Gwent Hospital, Newport; 2. South Tees – The James Cook University Hospital, Middlesbrough • Correspondence: Michael CY Nam, MD, Cardiology Department, Royal Gwent Hospital, Cardiff Road, Newport NP20 2UB, UK E: dr.michael.nam@gmail.com


Winter 2010 Tachycardia-induced Cardiomyopathy—A Fully Reversible Phenomenon 115


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