Non sustained ventricular tachycardia and apical cardiomyopathy
This presentation is the property of its rightful owner.
Sponsored Links
1 / 16

NON SUSTAINED VENTRICULAR TACHYCARDIA AND APICAL CARDIOMYOPATHY PowerPoint PPT Presentation


  • 132 Views
  • Uploaded on
  • Presentation posted in: General

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.

Download Presentation

NON SUSTAINED VENTRICULAR TACHYCARDIA AND APICAL CARDIOMYOPATHY

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Non sustained ventricular tachycardia and apical cardiomyopathy

Israel Aeromedical Center

NON SUSTAINED VENTRICULAR TACHYCARDIA AND APICAL CARDIOMYOPATHY

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


Case presentation

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 presentation1

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

Diagnosis

NSVT and Apical Cardiomyopathy

Should we grant a waiver?


Apical cardiomyopathy

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

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

NSVT and HOCM

  • EPS and AICD implantation- Not needed.


Waivers

Waivers

  • USAAF: VT associated to cardiomyopathy is permanently disqualifying.

  • USA NAVY: Permanent grounding.

  • USA ARMY: Permanent grounding.


Aeromedical consideration

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

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.


Non sustained ventricular tachycardia and apical cardiomyopathy

  • Exposure to G is arrythmogenic.

  • There is worsening is the disease pattern.


Factors in favor for granting a waiver

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

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 ├č-blockers and aspirin.

  • 24-rhythm monitoring X 4- normal


Non sustained ventricular tachycardia and apical cardiomyopathy

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


Non sustained ventricular tachycardia and apical cardiomyopathy

Thank You


  • Login