EKG of the Week 2017 12-17

This EKG comes courtesy of Dr. Elias Youssef.

A 44 year old male presented to the ED after a syncopal episode. The syncope occurred while he was walking. There were no premonitory symptoms. He had no chest pain, no shortness of breath. There was no recent travel, immobilization or surgery. His vital signs are normal.

His EKG is below.

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1.       What pattern is demonstrated by this EKG?

2.       How would you manage this patient?

 

ANSWER:

The EKG demonstrates Arrhythmogenic Right Ventricular Dysplasia.

Treatment for ARVD includes implantation of an ICD.

 

The EKG shows an atrially paced rhythm. There is a slightly widened QRS complex with T wave inversions in leads V1-V3. This is consistent with Arrhythmogenic Right Ventricular Dysplasia (ARVD).

ARVD is an inherited cardiomyopathy which causes fibrofatty replacement of the right ventricular myocardium. This leads to structural and functional abnormalities of the right ventricle and arrhythmias originating from the right ventricle.

In ARVD the EKG shows T-wave inversions in the right precordial leads (V2 and V3) with a prolonged QRS complex (>110 ms). There may also be Epsilon waves. These are small undulations in the ST segment just after the QRS complex. They are best seen in the right precordial leads. Epsilon waves are difficult to see on a standard EKG, so they should not be relied on for diagnosis. If you see T wave inversions in V1-V3 with a slightly widened QRS complex in the setting of syncope, suspect ARVD.

ARVD is diagnosed by MRI of the heart which shows the fatty infiltration of the right ventricle.

Treatment for ARVD includes implantation of an ICD.