When Pain Puts Your Heart in the Fast Lane: A Case of Ventricular Tachycardia Induced by Pain From Rib Fracture

Repetitive monomorphic ventricular tachycardia (RMVT) is the most common form of idiopathic ventricular tachycardia. It usually happens in patients with no history of cardiac disease. Many triggers have been described in the literature, specifically high catecholamine states such as surgery or acute illness. Here, we present a young patient with no past medical history who presented with acute onset right-sided upper back pain. An electrocardiogram (ECG) in the emergency room showed a wide QRS complex tachycardia with a left bundle branch morphology. The echocardiogram was significant for a reduced ejection fraction (EF) with severe global hypokinesis. She was evaluated by electrophysiology, who recommended initiating metoprolol tartrate, as the working diagnosis was thought to be RMVT. She underwent cardiac catheterization, which showed non-obstructive coronary artery disease (CAD). Upon further evaluation, she was found to have right-sided rib fractures that were not seen on the initial workup. Pain from the rib fracture was thought to be the triggering factor for her arrhythmia. Her tachycardia was resolved with beta blockers. The patient was discharged in a stable condition with electrophysiology follow-up for considering ablation.