Transient left ventricular aneurysm and hypertrophy accompanied by polymorphic ventricular tachycardia in a patient suspected of acute myocarditis

A 75-year-old woman presented with recurrent ventricular tachycardia (VT) c ompatible with torsades de pointes (TdP) based on sinus bradycardia and QT prolongation. Previously she had received pirmenol, at a serum concentratio n within therapeutic range, for her paroxysmal atrial fibrillation. Emergen t cardiac catheterization identified a ventricular aneurysm of the anteroap ical and inferior wall along with angiographically normal coronary arteries . A right ventricular endomyocardial biopsy revealed postmyocarditic change . The left ventricular contraction improved after 5 weeks of conservative t reatment. A follow-up echocardiogram revealed transient thickening of parti al left ventricular wail consistent with the segment of the aneurysm. Sever al months later, almost all abnormal findings had improved except for susta ined deep negative T waves in precordial leads. Acute myocarditis was prima rily suspected as the cause of her clinical presentation.