# Double Trouble in a Patient with Ischemic Cardiomyopathy and Severe Mitral Regurgitation: A Case Report

## TL;DR

A 56-year-old man with heart disease and severe mitral regurgitation experienced a rare combination of two arrhythmias, bidirectional ventricular tachycardia and atrial flutter.

## Contribution

This case report highlights the rare coexistence of bidirectional VT and AFL in a patient with ischemic cardiomyopathy and severe mitral regurgitation.

## Key findings

- The patient exhibited alternating QRS morphologies and axis changes consistent with bidirectional VT.
- AFL was diagnosed alongside the ventricular arrhythmia, complicating the clinical presentation and diagnosis.
- The case underscores the diagnostic challenges in patients with complex cardiac conditions.

## Abstract

Bidirectional ventricular tachycardia (VT) is a rare arrhythmia characterized by alternating QRS morphologies and axis changes. Atrial flutter (AFL) can coexist with ventricular arrhythmias, complicating diagnosis. We present a case of a 56-year-old man with a history of ischemic heart disease and severe mitral regurgitation admitted with palpitations who was diagnosed with dual tachycardia (bidirectional VT and AFL).