Syncope in a young man

 Written by Pendell MeyersLet ' s say a young person presented with exertional syncope. They are now at baseline, asymptomatic, normal vital signs, and they have this ECG at triage:What do you think?Below are two other variations of this patient ' s resting ECG from different time periods:Answer: Arrhythmogenic Right Ventricular CardiomyopathySee the end of the post for review and details on ARVC and it ' s ECG findings, but suffice to say that this patient has sinus rhythm, small epsilon wave in some of his ECGs, and R waves in V1-V3 with TWI.Here is a close up of V1-V3:Notice the very subtle micro-voltages at the J point.  These are epsilon waves.As a teenager, this patient was playing basketball when he suddenly collapsed and became unresponsive. EMS found him in ventricular fibrillation. He returned neurologically intact. During his hospitalization he received an ICD. Genetic testing confirmed arrhythmogenic right ventricular cardiomyopathy/dysplasia with a mutation in his desmoglein-2 gene. During hospitalization he was started in mexiletine for frequent uniform PVCs which seemed to significantly decrease ectopy burden. He was restricted from activity and later also metoprolol was added.Over the years he has had several ICD shocks, several medication adjustments, but is otherwise doing well. ARVD Review below, reproduced from this post: Young man with syncope while riding a bike [Arrhythmogenic Right Ventricular Dysplasia (ARVD)]ARVD, also known as ar...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs