Accelerated Ischemic Disease Presenting as Ventricular Fibrillation.

Introduction: Ventricular fibrillation (VF) is often associated with underlying structural heart disease and occurs in a small percentage of acute myocardial infarction (MI) cases. Specific conditions such as complete coronary occlusion, anterior wall infarction, and pre-existing conditions like atrial fibrillation or congenital abnormalities increase the risk of VF. In this report, we present the case of a 64-year-old male with a history of hypertension, HIV, and opioid dependence who developed VF during stress testing despite having no prior structural heart disease. This case supports the hypothesis that ongoing ischemia may trigger VF in the absence of structural heart disease.

Case presentation: A 64-year-old male with a medical history of hypertension, HIV, and opioid dependence presented with chest pain and dyspnea. The patient's ECG showed changes suggestive of an inferior myocardial infarction. During a dobutamine stress test, the patient developed VF and was successfully resuscitated. Subsequent coronary angiography revealed severe triple vessel disease, and the patient underwent coronary artery bypass surgery. He recovered well postoperatively and was discharged on dual antiplatelet therapy.

Conclusion: VF occurs in a significant percentage of MI patients and is often associated with coronary artery disease and acute thrombotic lesions. This case illustrates that even in the absence of structural heart disease, ischemia can trigger VF. Early identification and invasive management, such as coronary angiography and mechanical circulatory support, are critical for improving survival outcomes in these patients.