26 September 2023 MGOV10976

Copies to Dr Sitefane

RE: Mrs. Alda Artur

DOB: 07/05/1985

History

Mrs. Artur is a 38-year-old lady accompanied by her husband and an interpreter. She had an episode of what looks
like ventricular tachycardia. There was one episode after drinking a brutal fruit, she experienced a fast heartbeat,
shortness of breath, as well as pins and needles in her hands and feet. She was taken to hospital and given
intravenous medication, about 20 minutes later the arrythmia stopped. She was subsequently put on Amiodarone
and Bilocor, this was stopped 30 days ago. Currently she feels palpitations when she walks, no specific precipitants,
and no relieving factors. Aside from this she is very healthy. She has no shortness of breath, chest pain, orthopnea,
or dyspnoea.

Past medical history:

None

Past surgical history:

None

Gynae history:
She has 3 children, she does report having palpitations during her second pregnancy but thought this was normal.

Exercise history:
Stopped since being diagnosed with an arrythmia.

Family history:
Non-significant for cardiac disease.

Allergies:
None

Medication:
None

Social history:
She is employed, does not smoke, stopped drinking alcohol since the episode of arrythmia.
Clinical examination

BP 130/70mmHg Pulse 61bpm

Height: 1.72m Weight: 90kg

Well-looking with no pallor, pedal oedema, nail changes, neck mass , or audible carotid bruit.

Cardiovascular: all pulses are present equal and regular, heart sounds are normal, no audible murmurs

Respiratory: equal breath sounds bilaterally

Abdominal: soft with no organomegaly

Neurological: cooperative with no focal neurological deficit

ECG: sinus rhythm, heart rate 59bpm, PR 179ms, QRSd 80ms, QTc 410ms, cardiac axis 0. No evidence of an Epsilon
wave. Normal QT.

ECG during arrythmia showed a broad complex regular tachycardia, ventricular rate 200bpm. Axis is 90, it is right
bundle in morphology with positive concordance. ECG likely in keeping with LVOT ventricular tachycardia.

EST: She walked for 8 minutes, target heart rate was achieved, and no arrythmias noted.

Echocardiogram: LVEF 60%. Overall good LV function with no regional wall motion abnormalities. Mitral valve has
mild mitral regurgitation.

Assessment and plan:

Mrs. Artur is a 38-year-old lady with problems of outflow tract VT in the presence of a structurally normal heart. I
have suggested doing an EP study, and if we can induce the VT can be ablated. She will think over the option of an EP
study vs. medical therapy, I have mentioned that Amiodarone is not a good option and we could change to
Verapamil.

Thank you for the referral.

Kind Regards
Kavi
Dr K Govender