A 63-year-old gentleman with hypertension and a known history of ischemic heart disease, having undergone multiple PTCA procedures, presented with troubling episodes of dizziness and palpitations. Given his cardiac history, the first step seemed straightforward—but sometimes, the obvious path doesn’t reveal the full story.

A year earlier, he had experienced syncope, and at that time, a coronary angiography (CAG) showed patent stents and no visible blockages—offering temporary reassurance. But the recurrence of symptoms raised suspicion that something more elusive might be at play.

So this time, Dr. Priya Palimkar went beyond the angiogram. A Holter monitor captured episodes of ill-sustained ventricular tachycardia (VT)—an arrhythmia that, though brief, can be dangerous. A 2D echocardiogram added another layer to the diagnosis: the presence of a left ventricular apical clot.

With these critical findings, the treatment pathway became clear:

• Anticoagulation was started to address the clot
• The patient underwent the successful implantation of an AICD (Automatic Implantable Cardioverter Defibrillator)—a life-saving device designed to detect and correct life-threatening arrhythmias

He was discharged in stable condition, now protected from the silent but deadly threat of ventricular tachycardia.

This case is a powerful reminder: Even in patients with “normal” stents, there may be hidden electrical or structural issues that standard tests don’t reveal. Sometimes, all it takes is a deeper look—and a touch of clinical curiosity—to rewrite the outcome.