Polymorphic Ventricular Tachycardia (PMVT) in a Patient With Troponin-Negative Chest Pain: A Case Report and Literature Review

TL;DR

A patient with severe heart artery blockage experienced a dangerous heart rhythm without elevated heart injury markers, highlighting the need for thorough evaluation beyond blood tests.

Contribution

This case report highlights the clinical importance of recognizing high-risk coronary disease despite normal troponin levels in patients with arrhythmias.

Findings

A patient with critical LAD stenosis developed PMVT without troponin elevation.

Normal troponin levels did not rule out severe coronary pathology and life-threatening arrhythmia.

PCI successfully treated the underlying CAD, emphasizing the need for comprehensive evaluation beyond biomarkers.

Abstract

Polymorphic ventricular tachycardia (PMVT) is a potentially life-threatening arrhythmia, typically associated with acute myocardial ischemia or inherited channelopathies. We present a case of PMVT in the context of critical coronary artery disease (CAD) but without biomarker-evident myocardial injury, such as troponin elevation. We present a case of a 61-year-old man with critical left anterior descending (LAD) artery stenosis who developed symptomatic PMVT. This case highlights the paradox of negative troponin values despite severe coronary pathology and a life-threatening arrhythmia. Despite initial normal troponin levels, the patient’s recurrent chest pain and arrhythmias were ultimately attributed to critical LAD stenosis, which was successfully treated with percutaneous coronary intervention (PCI). This case emphasizes the importance of considering high-risk coronary disease, particularly in patients with exertional symptoms and arrhythmias, even when initial biomarkers may be reassuring. It underscores the importance of considering ischemia even when troponin levels are normal, particularly in patients with unstable angina. The case illustrates the limitations of relying solely on troponin for risk stratification in acute coronary presentations and supports the need for comprehensive clinical and electrocardiographic evaluation.

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