Ventricular fibrillation and coronary atherosclerosis with normal maximal exercise test

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Ventricular arrhythmias may cause sudden death in patients with coronary artery disease. A method of recognizing patients in whom this complication is likely to develop during periods of stress is desirable. Graded maximal exercise tolerance testing has been used for this purpose. Victims of this catastrophe rarely survive for diagnostic evaluation and therapeutic correction of the responsible cardiac lesions.1–3

We have recently studied the case of a patient in whom the initial manifestation of coronary artery disease was ventricular fibrillation during a strenuous tennis match. This patient did not experience symptoms of cardiac disease before cardiac arrhythmia, and he had a normal graded maximal exercise tolerance test during his diagnostic evaluation. Selective cine coronary arteriography was necessary for definitive diagnosis.

Case report

On July 9, 1971, a 50-year-old man collapsed while playing tennis. His tennis partner, a physician, began cardiopulmonary resuscitation and was assisted by a nurse who was nearby. On admission to the emergency room at a local hospital, an electrocardiogram showed ventricular fibrillation. Normal sinus rhythm was established by external electrical cardioversion. He remained in the hospital until July 20, 1971. Serial electrocardiograms showed no evidence of acute myocardial infarction. Non-specific S-T and T wave changes had reverted to normal at the time of discharge. Serum glutamic oxaloacetic transaminase (SGOT) and lactic dehydrogenase (LDH) values were elevated to 95 units/ml and 2,000 milliunits/ml (IU) respectively. The day after admission the patient complained of mild chest pain, which was attributed to external cardiac massage and electrical cardioversion.

He . . .



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