Ventricular storm following late presentation acute myocardial infarction.

A patient (aged mid-70s) was admitted following 4 days of chest pain and breathlessness. Investigations suggested a completed transmural anterior myocardial infarction (MI): ECG revealed anterior ST-elevation with anteroseptal Q waves (figure 1A); elevated troponin I (6.98 µg/L, normal range \u003c0.1 µg/L); echocardiography demonstrated severe left ventricular systolic dysfunction with anteroseptal akinesia; and chest radiograph demonstrated pulmonary congestion. Treatment received included intravenous furosemide and standard secondary prevention medications including bisoprolol 2.5 mg once daily (initiated 48 hours after admission). Coronary angiography, on day 7, demonstrated severe stenoses in the mid-left anterior descending (LAD) and proximal obtuse marginal (OM) arteries (figure 1B).\n\n\n\nFigure 1 \n(A) Admission ECG, (B) coronary angiography, (C) ECG morphology of unifocal premature ventricular complex and (D) telemetry recording showing polymorphic ventricular tachycardia and initiation (sweep speed 25 mm/s).\n\n\n\nDuring angiography …