28 August 2025
: Case report 
Management of Malignant Arrhythmia in Apical Hypertrophic Cardiomyopathy: A Case Report
Challenging differential diagnosis, Rare coexistence of disease or pathology
Ramesh Acharya ABCDEF 1*, Gerardo Gutierrez-Sierra BE 1, Vishakh Prakash BE 1, Suchita Acharya BE 1, Sandesh Murali ACDEF 1, Mehran Abolbashari CD 2DOI: 10.12659/AJCR.948875
Am J Case Rep 2025; 26:e948875
Table 2 The case timeline.
| Date | Events |
|---|---|
| Day 1 | A 41-year-old man with a history of TIDM and alcohol abuse presented to the Emergency Department with nausea and vomiting. He was found to have severe electrolyte imbalance and a non-sustained ventricular tachycardia. Urine drug screening was positive for cocaineEchocardiography showed severe apical hypertrophy with complete obliteration of the LV apex |
| Day 2 | The patient went into cardiac arrest due to sustained ventricular tachycardia and ventricular fibrillation. He was defibrillated twice and ROSC was obtained after 7 minutes. He was intubated for airway protection and was transferred to the Intensive Care Unit. He was started on IV amiodarone and IV lidocaine |
| Day 3 | He was started on a phenylephrine drip overnight because of hypotension. He tolerated the spontaneous breathing trial and was extubated. The amiodarone infusion was stopped and he was started on oral amiodarone 400 mg BID. Lidocaine and phenylephrine infusion continued |
| Day 4 | The lidocaine and phenylephrine drip was discontinued. He was scheduled for ICD implantation for secondary prevention of SCD |
| Day 5 | Transferred to a telemetry unit. Initiated on Librium 10 mg BID by Psychiatry for mild alcohol use withdrawal |
| Day 6 | Patient at baseline. On amiodarone 400 mg BID to complete a 10-day course of the same and then to transition to 400 mg OD |
| Day11 | Patient underwent subcutaneous ICD implantation. After the procedure, he was clinically stable |
| Day 12 | Discharged home on amiodarone 400 mg OD |
| TIDM – type 1 diabetes mellitus; ED – Emergency Department;V-Tach – ventricular tachycardia; UDS – urine drug screen; LV – left ventricle; ROSC – return of spontaneous circulation; V-Fib – ventricular fibrillation; SBT – spontaneous breathing trial; ICD – implantable cardioverter-defibrillator; SCD – sudden cardiac death; BID – twice a day; OD – once daily. | |