Incessant PVCs and Cardiomyopathy: Think Outside the Box

摘要

A 74-year-old African American male with nonischemiccardiomyopathy, premature ventricular contraction (PVC) status post ablation in 2010 and 2015, hypertension and hyperlipidemia presented with recurrent symptomatic PVCs. Prior work up included transthoracic echocardiogram in 2010, which showed LVEF 35–39% that improved to LVEF 50–55% post PVC ablation. Coronary angiogram at that time showed nonobstructive coronary artery disease. Due to recurrent symptomatic PVCs, he underwent further evaluation with a 48-hour Holter monitor, which showed 43,000 PVCs burden. Current medications, patient was on carvedilol 12.5 mg BID, lisinopril 40 mg daily, amlodipine 10 mg daily, atorvastatin 40 mg daily and aspirin 81 mg daily. Physical exam was otherwise unremarkable. Laboratory work up was otherwise unremarkable with normal electrolytes and low platelet count.