Palpitations and presyncope in a 40-something

Discussion: Putting all of the information together this patient is most likely suffering from arrhythmogenic cardiomyopathy (AC) better known as ARVC. The medical hx is typical, with sudden onset tachydysrhythmia during physical exertion. It is not uncommon for the initial presentation to be sudden cardiac death (SCD). In fact it is one of the leading causes of SCD in people age less than 40 years. Thus it is very important to identify this disorder. AC is a disease in which myocardium is replaced by fibrofatty tissue. This usually and predominantly affects the RV free wall and apical regions, but it can affect the left ventricle as well and this is why arrhythmogenic cardiomyopathy is a more precise name for the disorder than ARVC. Smith: The 5 entities I look for on all ECGs for patients with syncope who are asymptomatic on arrival with sinus rhythm and no ischemia is:1. WPW2. HOCM3. Brugada4. Long QT5. RV cardiomyopathyThe origin of the VT in our case is from the apical portion of the RV. There are signs of RV pathology on the ECG (T wave inversions in V1-V3). Ido not see anyepsilon waves in the post conversion ECG. T wave inversion extends throughout the precordial leads all the way to V6 signifying involvement also of the left ventricular myocardium. This was consistent with echocardiographic and MRi findings in this case. Atrial fibrillation too has an association with ARVC. Diagnosis of AC is based on the family hx, patient hx, electrocardiographic, echocard...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs