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Abstract: Frequent ventricular premature contraction is a type of ventricular premature contraction, which is more common in clinical practice, often induced by coronary artery disease, and can lead to symptoms of panic. In this case, the patient came to the hospital with panic for more than half a month, and the examination of cardiac ultrasound and coronary angiography suggested coronary artery disease and frequent ventricular asystole. After surgery and drug treatment, the condition was controlled and the frequent ventricular asystole improved significantly, and the patient’s panic symptoms disappeared.
Basic information】Female, 50 years old
Disease Type】Coronary heart disease, frequent ventricular asystole
Hospital】Harbin First Hospital
Date of consultation】May 2022
Treatment plan】PTCA + drug balloon dilatation + drug therapy (isosorbide mononitrate tablets, clopidogrel hydrogen sulfate tablets, aspirin enteric tablets, etc.)
Treatment period】7 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect]: The disease was controlled, the frequent ventricular asystole improved significantly, and the symptoms of panic disappeared.
I. Initial consultation
Through detailed communication, we learned that the patient had breast cancer 4 years ago and had undergone chemotherapy, and she had regular follow-ups on her breast problems. He had no previous history of hypertension, hyperlipidemia, or diabetes mellitus, and did not smoke. The electrocardiogram showed sinus rhythm with frequent ventricular anterior contractions. The initial diagnosis was arrhythmia and frequent ventricular asystole.
II. Treatment history
After the patient was admitted to the hospital, we first excluded whether he had coronary artery disease and whether he had severe coronary stenosis, and suggested him to undergo further coronary angiography, which revealed a stenosis of about 50% in the left anterior descending branch and 90% in the posterior interventricular branch, thus confirming the diagnosis of coronary artery disease and frequent ventricular asystole. After communicating with the patient and his family about his condition, it was decided to perform PTCA with pharmacological balloon dilation at the severe stenosis. The patient was also instructed to be on dual antiplatelet for six months, and the drugs were clopidogrel hydrogen sulfate tablets and aspirin enteric coated tablets. Intensive lipid-lowering therapy was given to reduce LDL to below 1.8 mmol/L, combined with subcutaneous injection of Eloizumab injection on top of Rosuvastatin calcium tablets. Besides, the patient was advised to take oral isosorbide mononitrate tablets to dilate blood vessels and improve myocardial ischemia. ECG examination was repeatedly performed during the treatment, and ECG monitoring was noted for the first 3 days of hospitalization.
III. Treatment effect
After the diagnosis of coronary artery disease was made clear, the patient was promptly treated with surgery, together with antiplatelet and lipid-lowering drugs. The patient was instructed to return to the hospital after 1 month for follow-up electrocardiogram, cardiac ultrasound, and lipids to clarify the recovery of the disease and assess the control of lipids.
IV. Precautions
After the relevant treatment, the patient’s symptoms of panic improved significantly and his body gradually recovered, and as a doctor, we are sincerely happy for the patient. However, patients must follow the doctor’s prescription for medication after discharge, because secondary prevention medication is crucial for patients with coronary artery disease with frequent ventricular premature contractions, and random discontinuation of medication may lead to acute myocardial infarction and acute heart failure. In the process of oral medication, pay attention to regular review of liver function and kidney function, and also pay attention to physical examination once every six months to one year. In daily life, we should avoid straining and staying up late, work and rest regularly, keep a happy mood, eat a low-salt and low-fat diet, pay attention to a balanced diet, and increase the intake of whole grains.
V. Personal insight
Ventricular period contraction is a common cardiac arrhythmia, and if it manifests itself frequently, patients can often experience panic and palpitations, and some patients may also feel a sense of cardiac arrest on their own. Therefore, if one feels cardiac discomfort, it is important to seek prompt medical attention and a clear diagnosis. For more serious frequent ventricular precontractions, one must be highly alert to the occurrence of organic heart disease, such as coronary artery disease, and should be carefully examined as well as treated.