Non sustained ventricular tachycardia and apical cardiomyopathy
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NON SUSTAINED VENTRICULAR TACHYCARDIA AND APICAL CARDIOMYOPATHY PowerPoint PPT Presentation


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Israel Aeromedical Center. NON SUSTAINED VENTRICULAR TACHYCARDIA AND APICAL CARDIOMYOPATHY. Dan Carter MD , Bela Azaria MD, Liav Goldstein MD,MHA. Case Presentation. 49 y\o A-4 (Skyhawk) weapon system operator (WSO). Medical history: Hepatitis 1983.

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NON SUSTAINED VENTRICULAR TACHYCARDIA AND APICAL CARDIOMYOPATHY

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Israel Aeromedical Center

NON SUSTAINED VENTRICULAR TACHYCARDIA AND APICAL CARDIOMYOPATHY

Dan Carter MD, Bela Azaria MD, Liav Goldstein MD,MHA


Case Presentation

  • 49 y\o A-4 (Skyhawk) weapon system operator (WSO).

  • Medical history: Hepatitis 1983.

  • 1999- Inverted T waves in routine E.C.G.(V1-V6)

    Stress test: ST depression.

    Echocardiography: Concentric hypertrophy. Septal-basal Hypertrophy. No SAM. No outflow obstruction. (septum 12 mm)


Case Presentation

  • 2002: Cardiac catheterization: Normal coronaries. Spade shape on ventriculography.

    24 h ECG recording: Normal.

  • 2004: 24 h ECG recording: 15 sec NSVT 160 beats\minute (asymptomatic).

    Stress test: No evidence of arrhythmia.


Diagnosis

NSVT and Apical Cardiomyopathy

Should we grant a waiver?


Apical Cardiomyopathy

  • A subtype of HOCM.

  • More common in the far east.

  • Symptoms: Atypical chest pain, effort dyspnea, palpitations. (57% of patients).

  • Usually good prognosis.

    Ventricular cariomyopathy with ventricular septal hypertrophy localized to the apical region of the left venticle. Maroon et al. Am J Cardiol 1982.


Risk factors for sudden death in HOCM

Major risk factors:

Cardiac arrest ( ventricular fibrillation)

Spontaneous sustained ventricular tachycardia

Family history of sudden death

Minor risk factors:

Left ventricular wall thickness > 30 mm

Abnormal blood pressure on exercise

Non sustained ventricular tachycardia

Left ventricular outflow obstruction

Microvascular obstruction

High risk genetic defect


NSVT and HOCM

  • EPS and AICD implantation- Not needed.


Waivers

  • USAAF: VT associated to cardiomyopathy is permanently disqualifying.

  • USA NAVY: Permanent grounding.

  • USA ARMY: Permanent grounding.


Aeromedical consideration

  • What are the chances for a catastrophic event during flying?

  • What will be the result of such an event?

  • Does the flying environment enhance the risk for a catastrophic event?


Factors in favor for grounding

  • Idiopathic NSVT -0.33% annul hemodynamic compromise.

  • MR and NSVT- 2.3% annul hemodynamic compromise.

  • NSVT and IHD or cardiomyopathy- the worst prognosis.

    Non sustained ventricular tachycardia in 193 u.s. military aviators: long term follow up. ASEM 2000.


  • Exposure to G is arrythmogenic.

  • There is worsening is the disease pattern.


Factors in favor for granting a waiver

  • The total risk for sudden death is HOCM is less then 1%.

  • NSVT in HOCM is associated with more 1.9 increase in the risk for sudden death (which is less then 1% annually).

  • The aviator is a WSO.

  • The aviator is exposed to 2-3G.

  • The aviators wants to continue his aviation duties.


Decision

  • A waiver was granted for low performance platforms.

  • Subsequently, he developed atrial fibrillation after an exercise. Converted to sinus rhythm with propafenone.

  • Grounded.

  • Now treated with ß-blockers and aspirin.

  • 24-rhythm monitoring X 4- normal


  • Returned to operation as a instructor on low performance platforms.


Thank You


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