P1601Ventricular tachycardia of unusual etiology

Abstract

Introduction: Apart from Coronary artery disease, left ventricular tachycardia may result from cardiac sarcoidosis, left ventricular tumor, chagas disease and idiopathic left ventricular tachycardia. Methods: N/A Results: A 45 year old male, worker of stone cutting factory, presented with sustained monomorphic ventricular tachycardia of right bundle branch morphology(Fig: 1A). The tachycardia was resistant to DC Cardioversion. Frontal chest radiograph reveals bilateral reticulonodular shadows involving both lung fields and all zones (1B). Echocardiography showed Normal Biventricular function. Axial CECT chest revealed presence of multiple mediastinal nodes showing egg-shell calcification along with presence of fibrocalcific apical masses in both lungs (1C). Coronary angiography showed normal coronaries. Contrast enhanced cardiac MRI (CMRI) revealed delayed LGE in basal anteroseptal and inferoseptal part of left ventricular myocardium. Transbronchial lung biopsy showed focal fibrosis with pigment deposition (1D). A histological specimen from the right ventricular endocardium documented perivascular fibrosis (1E & 1F). Extra pulmonary silicosis usually involves lympnode, Spleen, liver and kidney. The pathological manifestations are fibrosis with or without silica particles. Mechanisms of extra pulmonary fibrosis include direct fibrogenic potential of silica and activation of immune system. Autoimmune diseases like systemic sclerosis are also increased in association with silicosis. Although pericardial fibrosis, has been reported, to the best of our knowledge, this is the first case of myocardial fibrosis in association with silicosis. Conclusion: We report a rare case of incessant left ventricular tachycardia due to myocardial fibrosis in a patient of silicosis.