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

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.

48 hours holter monitor