VCOM Louisiana Research Day Program

Clinical & Case Studies

Mihir Patel, OMS-III; Rakin Areef, OMS-III; Prajwal Shreedar, MD Willis Knighton Health Systems 26 A RARE CASE OF IATROGENIC CARDIAC R ON T PHENOMENON

R on T phenomenon is a rare condition where the ventricular depolarization superimposes on previous ventricular repolarization which results in vent arrythmia and that can lead to cardiac arrest. This is a type of premature ventricular contraction that occurs at or near the T wave apex, electrophysiologic ally this happens during the relative refractive period. In a normal heart the PVC when produced during the vulnerable period produces no malignant ventricular arrythmias, however in patient with myocardial ischemia or Brugada syndrome these are of importance as the patients are at a risk for ventricular fibrillation or polymorphic VT. A 71-year-old African American male patient with history of coronary artery disease underwent coronary artery bypass graft 3 vessel and was admitted for ICU level of care post operatively. Post operative day 2 the patient was seen to be unresponsive and was noted to be in ventricular fibrillation, with 12 lead EKG showing R on T phenomenon with poor cardiac reserve low EF in cardiogenic shock. He was taken to catheterization lab for eval of grafts and later LVAD Impella device was placed for support because of stunned LV. This is a rare event that occurs in patients with cardiac conditions-

conditions like-COPD, Sleep apnea syndrome, Pulmonary Hypertension. R on T phenomenon is a type of premature ventricular contractions that is characterized by ventricular depolarization superimposing on preceding ventricular repolarization. Epicardial pacing, although effective in managing low cardiac output and bradycardia in patients s/p CABG, should be used vigilantly in order to avoid critical arrhythmias. There are not many cases available in literature describing the rare R on T phenomenon but it is important to be familiar with the presentation since this can be a life threatening incident especially if the patient has a coexisting cardiac abnormality.

Acute MI, HF, myocarditis, Hypertrophic cardiomyopathy etc. and in non-cardiac

39 2023 Via Research Recognition Day