Straight back syndrome and frequent ventricular premature beats 

A 29-year-old woman presented to our hospital with intermittent palpitation for 1 year. Electrocardiography (ECG) showed premature ventricular beat (Panel A), and echocardiography did not reveal any abnormality. Further 24-h Holter monitoring indicated frequent ventricular premature beats (FVPBs) (10024 beats). Cardiac magnetic resonance (CMR) was recommended to exclude structural heart disease, such as cardiomyopathy. The results showed an absence of natural curvature of the upper dorsal spine, significantly decreased anteroposterior diameter at the T8 level (the ratio of anteroposterior (red line)/lateral (green line) diameter was 0.24, Panel B), the disappearance of precardiac space and compression of the right ventricular outflow tract (RVOT) (Panel C, see Supplementary data online, Video S1), while no hemodynamic disturbance was observed (Panel D, see Supplementary data online, Video S2). No other abnormalities were seen on the CMR examination. Based on the above information, the diagnosis of the straight back syndrome (SBS) was considered. The FVPB was considered to be related with the compression of RVOT, which was consistent with the ECG changes (Panel A, origin of the free wall of RVOT). The patient was reassured and advised to visit the orthopaedic or rehabilitation departments. One month later, the patient was followed up without obvious discomfort.

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SBS is a congenital abnormality of the upper dorsal spine characterized by loss of natural curvature of the spine and can mimic structure heart disease in some patients. For patients with FVPB, in addition to structural heart disease, the possibility of SBS should also be considered to avoid missed diagnosis and misdiagnosis. Importantly, the correlation between SBS and FVPB deserves further investigation.

Supplementary data are available at European Heart Journal - Cardiovascular Imaging online.

Author notes