Solving the puzzle of strong French coffee, palpitation and dizziness

Abstract

SUMMARYA 38-year-old gentleman presented to the emergency department at the University Hospital in Geneva with nausea, rapid palpitation and presyncope. This was followed by a poor night's sleep, a day of strenuous walking in the city and drinking a large quantity of strong French coffee. 12-lead ECG revealed tachycardia with slightly increased QRS duration of right bundle branch block pattern and left axis deviation. Without the electrophysiological (EP) study, the patient was diagnosed with supraventricular tachycardia. On return to Edinburgh, he was investigated under the EP study, which confirmed fascicular tachycardia, a rare and uncommon presentation of ventricular tachycardia. The patient was successfully treated with radiofrequency catheter ablation therapy, which is curative in over 80% of the cases. This case highlights the importance of referring patients with repeatedly presenting arrhythmic episodes to undergo EP study. This will avoid putting them at unnecessary future risk, while offering the opportunity to definitely diagnose and provide curative therapy. BACKGROUND

Taquicardia ventricular idiopática fascicular posterior izquierda. Presentación de un caso

“…3 En 1981, Belhassen et al, demostraron que el verapamilo era útil en su tratamiento y en la prevención de recurrencias. 4 Son típicas de varones jóvenes (15-40 años) y aunque suelen ocurrir en reposo, pueden inducirse por las catecolaminas en situaciones de estrés emocional o ejercicio. 5 Como el resto de las TV idiopáticas, se originan en pacientes sin evidencia de cardiopatía estructural, alteraciones electrolíticas, metabólicas o enfermedades eléctricas primarias.…”

Coffee: A Selected Overview of Beneficial or Harmful Effects on the Cardiovascular System?

“…Park and Grubb reported on a 38 year-old male patient with nausea, rapid palpitations, and presyncope, which occurred in association with the consumption of a large amount of strong French coffee. [14] His electrocardiogram showed a tachycardia with a slightly increased QRS duration of right bundle branch block pattern with left axis deviation and supraventricular tachycardia was initially diagnosed. With a subsequent electrophysiologic study, he was found to have a fascicular tachycardia as a rare presentation of ventricular tachycardia.…”