56M Recurrent Symptomatic Tachyarrhythmia in a 56-Year-Old Yoga Instructor with Previously Undiagnosed Non-Obstructive Hypertrophic Cardiomyopathy

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A 56-year-old male, working as a Yoga Instructor for the last 22 years, physically active, non-diabetic, non-hypertensive, occasional alcohol consumer, with no prior documented cardiovascular illness, presented with recurrent symptomatic tachyarrhythmia.


Prior to October 2025

The patient was apparently healthy and leading an active lifestyle as a professional yoga instructor.

He denied:

  • Hypertension
  • Diabetes mellitus
  • Coronary artery disease
  • Heart failure
  • Syncope
  • Previous palpitations
  • Previous hospitalization for cardiac illness

There was no history of chronic medication use.


First Cardiac Event

08 October 2025

Symptom Onset

At approximately 1 PM, the patient developed sudden onset:

  • Chest discomfort
  • Profuse sweating
  • Giddiness
  • Palpitations

This was the first episode of such symptoms in his lifetime.

Because of persistence of symptoms, he attended a nearby local hospital.


Initial Evaluation at Local Hospital

An ECG performed at the local hospital reportedly VT ( but ECG not available )

The patient remained hemodynamically stable.

Initial Intervention

He received:

  • Intravenous Amiodarone (Cordarone) 300 mg bolus
  • Followed by continuous Amiodarone infusion

Following treatment, the tachyarrhythmia terminated and sinus rhythm was restored.





The patient was then referred to a tertiary care cardiac center for further management.


Admission to Tertiary Care Center

08 October 2025

Chief Complaints on Arrival

  • Chest discomfort
  • Sweating
  • Recent episode of ventricular tachycardia


Clinical Examination

General Examination

  • Conscious and oriented
  • Temperature: 98.1°F
  • Pulse rate: 75/min
  • Blood pressure: 160/100 mmHg
  • Respiratory rate: 18/min

Cardiovascular Examination

  • S1 normal
  • S2 normal
  • No significant murmur documented

Respiratory Examination

  • Bilateral air entry present

Abdominal Examination

  • Soft
  • Non-tender
  • Bowel sounds present


Initial Investigations

Hematology

CBC

  • Hemoglobin: 17.4 g/dL
  • Total WBC count: 12,200/mm³
  • Platelets: 2.99 lakh/mm³

Peripheral Smear

  • Normocytic normochromic picture
  • Neutrophilic leukocytosis


Renal Function and Electrolytes

  • Creatinine: 0.8 mg/dL
  • Potassium: 4.5 mmol/L

No obvious metabolic trigger for VT was identified.


Blood Glucose

  • Random plasma glucose: 100 mg/dL


Cardiac Biomarkers

Troponin

  • Troponin-I: 9.36 ng/mL
  • Troponin-T: Positive

This suggested myocardial injury secondary to sustained tachyarrhythmia and/or underlying myocardial disease.


Electrocardiographic Evaluation

Post-Conversion ECG

Following conversion to sinus rhythm, ECG showed:

  • Sinus rhythm
  • Heart rate approximately 72/min
  • First-degree AV block (PR 218 ms)
  • QRS duration 130 ms
  • Left ventricular hypertrophy pattern
  • Lateral repolarization abnormalities
  • T-wave inversion in lateral leads
  • Intraventricular conduction delay/LBBB-like morphology


Echocardiographic Evaluation

Bedside 2D Echocardiography

Structural Findings

  • LVEDD: 4.2 cm
  • LVESD: 2.8 cm
  • EF: 60%

Hypertrophy

  • IVS thickness: 2.1 cm
  • LVPW thickness: 1.7 cm

Additional Findings

  • Asymmetrical septal hypertrophy
  • No LVOT obstruction
  • No systolic anterior motion (SAM)
  • No regional wall motion abnormality
  • Grade I diastolic dysfunction
  • Trivial MR/TR

Echocardiographic Diagnosis

Non-obstructive Hypertrophic Cardiomyopathy (HCM)

with

Asymmetrical Septal Hypertrophy


Hospital Course

After diagnosis of HCM, the patient was shifted to the ICU for close monitoring because of:

  • Sustained VT at presentation
  • Positive troponin
  • Potential risk of sudden cardiac death

Continuous cardiac monitoring was continued.

No further ventricular arrhythmias were documented during hospitalization.


Coronary Angiography

09 October 2025

Because of:

  • Positive troponin
  • Ventricular tachycardia
  • Chest discomfort

Coronary angiography was performed.

Findings

Left Main

  • Normal

LAD

  • Mild disease in mid-LAD
  • Distal LAD normal

Diagonal Branches

  • Mild disease

LCX

  • No significant obstructive disease

RCA

  • No significant obstructive disease

Additional Finding

Diffuse coronary slow flow noted in:

  • LAD
  • Diagonal branches
  • LCX branches
  • RCA


Final Diagnosis During October 2025 Admission

  1. Hypertrophic Cardiomyopathy (HCM)
  2. Asymmetrical Septal Hypertrophy
  3. Sustained Ventricular Tachycardia converted to NSR with Amiodarone
  4. Troponin-positive myocardial injury
  5. Mild Coronary Artery Disease
  6. Coronary Slow Flow Phenomenon
  7. Grade I Diastolic Dysfunction


Discharge Advice (October 2025)

Because the patient had:

  • Documented sustained VT
  • Structural heart disease (HCM)

He was advised:

AICD implantation

for secondary prevention of sudden cardiac death.

The patient was discharged in stable condition.


Intervening Period

October 2025 – June 2026

Following discharge:

  • Patient resumed routine activities.
  • Continued professional work as a yoga instructor.
  • No hospital admissions reported.
  • No documented syncope.
  • No heart failure symptoms.

He remained functionally active.


Second Cardiac Event

June 2026

Triggering Event

While travelling, the patient’s scooter stopped functioning.

He pushed the scooter manually for a short distance.

During this exertion he developed:

  • Sudden sweating
  • Giddiness
  • Palpitations
  • Mild chest discomfort

The symptoms were remarkably similar to the episode experienced in October 2025.


Emergency Department Presentation

On arrival:

  • Patient was conscious
  • Hemodynamically stable

ECG demonstrated:

Supraventricular Tachycardia (SVT)

rather than ventricular tachycardia.




Intervention

The patient received pharmacological therapy for SVT.

Following treatment:

Successful conversion to Normal Sinus Rhythm (NSR)

was achieved.



Symptoms resolved after conversion.







Current Clinical Status

The patient now has:

Structural Cardiac Disease

  • Non-obstructive HCM
  • Asymmetrical septal hypertrophy

Documented Arrhythmias

  • Sustained Ventricular Tachycardia (October 2025)
  • Supraventricular Tachycardia (June 2026)

Coronary Findings

  • Mild non-obstructive CAD
  • Coronary slow-flow phenomenon

Ventricular Function

  • Preserved LV systolic function (EF 60%)

 

https://youtu.be/fAZ5ji6djJo


One-Line Chronological Summary

A previously healthy 56-year-old yoga instructor experienced his first-ever episode of sweating, giddiness, chest discomfort, and palpitations in October 2025, was found to have sustained ventricular tachycardia that responded to intravenous amiodarone, underwent evaluation revealing non-obstructive hypertrophic cardiomyopathy with asymmetric septal hypertrophy and mild CAD with coronary slow flow, was advised AICD implantation, remained asymptomatic for eight months, and re-presented in June 2026 with exertion-induced sweating, giddiness, and palpitations while pushing a scooter, during which ECG demonstrated SVT that was successfully pharmacologically converted to normal sinus rhythm.


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