Key result
A 71-year-old man with subarachnoid hemorrhage developed recurrent polymorphic ventricular tachycardia despite maintaining a normal QTc interval, suggesting an alternative arrhythmogenic mechanism.
Case Report (n=1)
No
Polymorphic ventricular tachycardia can occur secondary to subarachnoid hemorrhage even in the absence of QTc prolongation, likely driven by autonomic nervous system dysfunction and catecholamine surge.
Clinicians should consider neurogenic polymorphic VT in subarachnoid hemorrhage despite normal QTc; case-level data leave open autonomic mechanisms for prospective study.
Subarachnoid hemorrhage (SAH) is a neurologic emergency associated with high mortality rate. Polymorphic ventricular tachycardia (VT) is a rare arrhythmia. It can occur in any setting of a long QT interval and bradycardia. This may result from a cardiomyopathy (both ischemic and non-ischemic), acute coronary ischemia, congenital long QT syndrome, electrolyte disturbances and cerebrovascular diseases. We report a rare case of polymorphic VT of unclear etiology with a normal corrected QT, likely secondary to SAH. Reports associating ventricular arrhythmias and SAH have been described, yet the mechanism of this association remains unclear. Previous observations of VT seen in patients with SAH suggest a relationship with QT prolongation. The QT interval, however, remained normal in our patient, suggesting an alternative and unknown mechanism for the polymorphic VT.
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Shah et al. (2017) conducted a case report in Subarachnoid hemorrhage and polymorphic ventricular tachycardia (n=1). Subarachnoid hemorrhage was evaluated on Development of polymorphic ventricular tachycardia. A 71-year-old man with subarachnoid hemorrhage developed recurrent polymorphic ventricular tachycardia despite maintaining a normal QTc interval, suggesting an alternative arrhythmogenic mechanism.
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