A 51-year-old patient was admitted with
chest pain and broad complex
ventricular tachycardia. He received three consecutive direct
cardioversion (DC) shocks and was commenced on
amiodarone infusion via a
central venous catheter or central line (CVC). He responded to treatment and normal sinus rhythm (NSR) was achieved. He had elevated
troponin I and underwent coronary angiogram which initially was thought to be responsible for his
ventricular tachycardia. Coronary angiogram (CAG) showed unobstructed coronary arteries. He was recently diagnosed with
pheochromocytoma and was commenced on
Phenoxybenzamine 10 mg two months back. He developed
ventricular tachycardia (VT) again the next day that did not respond to four consecutive direct
cardioversion shocks (DC) and antiarrhythmic medications. He was intubated and ventilated to terminate his VT and was transferred to the intensive care unit (ICU). He remained intubated for 48 hours and he remained in NSR, after which he was extubated. He was commenced on
bisoprolol and was later stepped down to the coronary care unit (CCU). Cardiac magnetic resonance imaging (CMR) showed left ventricular non-compaction (LVNC) or possibly
myocarditis in view of patient's known history of
pheochromocytoma. He was discussed with surgical team at another hospital for surgical resection of the adrenal
tumor and had a few further runs of VT while he was waiting to be transferred. The patient finally underwent surgical resection of the
tumor and was booked for
implantable cardioverter defibrillator (ICD) in view of his VT. This was an interesting case of treatment-resistant VT driven by
pheochromocytoma and LVNC, and it is important to be familiar with the fact that conventional
therapies may fail in these patients and may require intubation and ventilation to terminate VT storms.