Palpitations during sleep as the sole symptom of ventricular tachycardia: A case report

Introduction: Palpitations are a common symptom and are usually benign. However, they may be the sole manifestation of life-threatening ventricular tachycardia and significant coronary artery disease. Case report: A 57-year-old man was awakened from sleep by a sensation of pounding in his chest and irregular heartbeats. He reported no chest pain or loss of consciousness. His medical history included type 2 diabetes mellitus and hyperlipidaemia. His blood pressure was 150/102 mmHg, and his heart rate was 165 beats/min. An electrocardiogram (ECG) revealed wide-QRS-complex ventricular tachycardia with a left bundle branch block morphology at a rate of approximately 160 beats/min. Intravenous amiodarone restored sinus rhythm. Further diagnostic evaluation revealed significant stenosis of the left anterior descending (LAD) coronary artery. Percutaneous coronary intervention was subsequently performed, with implantation of a single drug-eluting stent and drug-coated balloon angioplasty of the mid-LAD segment. Conclusion: Palpitations can be the sole symptom of a serious arrhythmia. Early prehospital assessment, including ECG, continuous monitoring, and evaluation of haemodynamic status, is essential for prompt recognition and initial management, while appropriate transport ensures timely access to definitive cardiac care.