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J Korean Soc Emerg Med > Volume 32(5); 2021 > Article
Journal of The Korean Society of Emergency Medicine 2021;32(5): 467-470.
Exercise-induced polymorphic ventricular tachycardia by the R-on-T phenomenon in a patient with stable angina pectoris
Jong Wook Beom , Yeekyoung Ko , Ki Yung Boo , Jae-Geun Lee , Joon Hyouk Choi , Song-Yi Kim , Seung-Jae Joo
Division of Cardiology, Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
Correspondence  Seung-Jae Joo ,Tel: 064-717- 1296, Fax: 064-717-1130, Email: sejjoo@jejunu.ac.kr,
Received: February 10, 2021; Revised: April 3, 2021   Accepted: April 20, 2021.  Published online: October 31, 2021.
Polymorphic ventricular tachycardia (PVT) is a fatal arrhythmia that can occur during the treadmill test. This report documents an instance of PVT by the R-on-T phenomenon during an exercise stress test in a 61-year-old male with stable angina pectoris. The subject performed the treadmill test for 581 seconds, and stopped after reaching 115% of the target heart rate. Ischemic ST changes were observed in leads II, III, aVF, and V3-V6 from stage 3. Premature ventricular complexes were noted during the recovery period, with an occurrence of pulseless PVT, reflective of the R-on-T phenomenon. Spontaneous circulation was resumed after unsynchronized cardioversion at 200 J and 2 minutes of cardiopulmonary resuscitation. Emergency coronary angiography revealed 95% stenosis of the proximal right coronary artery, which was fully dilated after percutaneous coronary intervention with a drug-eluting stent. The patient was discharged without any neurologic sequelae.
Key words: Angina, stable; Treadmill test; Premature ventricular complexes; Ventricular tachycardia
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