Postgrad Med J: first published as 10.1136/pgmj.31.354.191 on 1 April 1955. Downloaded from
I9I -J PAROXYSMAL VENTRICULAR TACHYCARDIA OCCURRING IN A NORMAL HEART By DAVID ROMNEY, M.B., B.Ch.(Dub.) Ex-Senior House Officer in Medicine, St. James's Hospital, Balham
It is widely taught-and rightly so-that by sinus pressure will, of course, not affect the paroxysmal ventricular tachycardia is one of the rate in ventricular tachycardia. rarer arrhythmias, and is associated with grave In I953 Froment, Gallavardin and Cahen myocardial damage, with special reference to myo- offered a classification of various forms of cardial infarction. It is the least common, and paroxysmal ventricular tachycardia, and included most serious of the paroxysmal tachycardias, some case report. They described the following which contain four varieties of arrhythmia: supra- groups:- ventricular (auricular and nodal) 60 per cent.; (i) Terminal prefibrillatory ventricular tachy- auricular fibrillation, 30 per cent.; auricular flutter, cardia. 6 per cent.; and ventricular tachycardia, 4 per (ii) Curable and mild monomorphic extra- cent. systoles, with paroxysms of tachycardia.
Figures from various sources (Campbell, 1947) (iii) Paroxysmal ventricular tachycardia due toby copyright. would indicate that in the latter group, four-fifths a lesion of the ventricular septum. of the cases had seriously damaged hearts. In (iv) Persistent and prolonged ventricular tachy- the remaining fifth no cause was found for the cardia developing in sound hearts, usually paroxysms. Paroxysmal ventricular tachycardia is in young subjects. more common in men than in women in the proportion of about 3.2. This arrhythmia was Case Report first identified by Sir Thomas Lewis in I909 and A married woman, aged 48, first became aware Gallavardin (1920, I921, 1922) emphasized the in 1948 of a paroxysm which caused alarm, faint- seriousness of the 'terminal ven- ness and It lasted a short pre-fibrillatory collapse. only time, http://pmj.bmj.com/ tricular tachycardia,' and also described a less and past history was completely negative fromthe common type characterized by short attacks with point of view of cardiac symptoms, rheumatic frequent extrasystoles. Also at this time work phenomena, etc. At this stage she was seen at was published by various authors which stressed the National Heart Hospital, and clinical, radio- myocardial infarction as the precipitating cause logical and electrocardiographic examination was of the attacks, and pointed out the therapeutic normal. Later she became aware of a ' fluttering action of quinidine in these. Froment (1932) in the throat' from time to time, which gradually. classified paroxysmal ventricular tachycardia and seemed to pass off after a few hours, and give on September 30, 2021 by guest. Protected included a subgroup of paroxysms occurring in rise to no real discomfort once she became used normal hearts, and since then several large series to it. of cases have been reported, among which were In October I953 the paroxysms became more Campbell (1947) and Armbrust and Levine (1950). prolonged and she sought medical advice. She Aids to the diagnosis of paroxysmal ventricular was seen in St. James's Hospital, Balham. At tachycardia by the bedside are said to be varied that time her E.C.G. was normal, and no abnor- intensity of the first heart sound and slight mality was found on clinical examination except irregularity on careful auscultation; although these occasional extrasystoles. She continued to complain may be present, their appreciation by the human of attacks, and quinidine was employed, but this ear at rates of 200 per minute is another matter. merely added nausea and sweating to the discom- Campbell considers that the rate per minute does fort of the paroxysms which were then lasting up not help in distinguishing ventricular and auricular to days at a time. tachycardias, and that the faster rates were found In November I953 the first E.C.G. of the in the more healthy hearts because these alone arrhythmia was obtained which illustrated numer- could survive at these rates. Vagal stimulation ous extrasystoles occurring at a rate of about 200 G1 Postgrad Med J: first published as 10.1136/pgmj.31.354.191 on 1 April 1955. Downloaded from 192 POSTGRADUATE MEDICAL JOURNAL April 1955 .7r. 1-T -t ...... q . . -.- Tr . .m 3:Es . 'To- . rrs * . * x ...... -L l l .|w--N*,-H:--4rr .tr ; r t a : -r;; - -::t4+ - l t -n: r t-i-T c -s lw-1 -4 - l k | -. l k ig .. mr + |- i sITg ^| - - W- i . i1" Et- - 1l E |M*l kEiti3YL1d %-x tHHi...... L a +lt {rfitt|att si *1 if -5 5dg- gw g| tRl " [1"1 tl t-t - -ri ; T Ni= r i= | sii N .i -i :- - -^ -rs a^ | | X | s s s s s s
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' R- rTTI by copyright. Summary mission to publish this case and for helpful advice. A case of idiopathic paroxysmal ventricular My thanks are also due to Mr. D. Welsh for the tachycardia is reported. Some of the literature electrocardiograms. on paroxysmal ventricular tachycardia is reviewed, a classification of of this ar- including types BIBLIOGRAPHY rhythmia. ARMBRUST and LEVINE (1950), Circulation, I, 28. The characteristic features of the two main CAMPBELL (1947), Lancet, ii, 641 and 68I. DIEVADE and DAVIDSON Arch. Int. types occurring in apparently normal hearts is (1921), Med., 27, 663. http://pmj.bmj.com/ FROMENT, R. (1932), 'These de Lyon. Masson et Cie,' edit. discussed, including the resistance to treatment Paris. of the type characterized by. extrasystoles, with FROMENT, GALLAVARDIN and CAHEN (1953), Brit. Heart of Journal (April). paroxysms tachycardia. GALLAVARDIN, L. (1920), Arch. Mal Coeur, 13, I2I. I should like to thank Dr. B. Barling for per- GALLAVARDIN, L. (1922), Ibid, 15, 298. on September 30, 2021 by guest. Protected
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