Shot through the heart: A rare cause of asymptomatic Vn

Suzannah Bownes, Thomas Goubar, Daniel T. Tardo, Joseph J Suttie

Abstract

Chronic intramural cardiac foreign bodies are a rare cause of asymptomatic ventricular arrhythmias.

We report the case of a 54-year-old man referred for optimisation of cardiac risk factors on a background of hypertension and hypercholesterolaemia, with an incidental finding of frequent ventricular ectopy of varying morphology during stress echocardiogram despite normal resting 12-lead-electrocardiogram. Subsequently, a 24-hour Holter monitor was performed which demonstrated 511 ectopic beats with one run of non-sustained ventricular tachycardia lasting 11 beats, despite remaining asymptomatic during the period of recording. At this time additional history was elucidated, indicating previous penetrating shrapnel injury whilst hunting at the age of 15, resulting in multiple foreign bodies becoming embedded in the myocardium. Plain chest radiograph showed multiple radio-opaque fragments throughout the mediastinum, confirmed on CT coronary angiogram which also excluded coronary artery disease as a possible cause of his burden of ventricular arrhythmias.

This case report is the first description in the literature of this rare clinical entity, which presents ongoing challenges surrounding the long term management of a complex issue in an otherwise young, healthy and active male.