title: Arrhythmogenic right ventricular dysplasia: Atypical clinical presentation.
abstract: A 67-year-old man was admitted to our hospital after episodes of syncope preceded by malaise and diffuse neck and chest discomfort. No family history of cardiac disease was reported. Laboratory workup was within normal limits, including D-dimers, serum troponin I and arterial blood gases. The electrocardiogram showed sinus rhythm with T-wave inversion in leads V1 to V3. Computed tomography angiography to investigate pulmonary embolism showed no abnormal findings. Transthoracic echocardiography (TTE) displayed massive enlargement of the right ventricle with intact interatrial septum and no pulmonary hypertension. Cardiac magnetic resonance imaging (MRI) confirmed right ventricular (RV) dilatation and revealed marked hypokinesia/akinesia of the lateral wall. Exercise stress testing was negative for ischemia. According to the 2010 Task Force criteria for arrhythmogenic right ventricular dysplasia (ARVD), this patient presented two major criteria (global or regional dysfunction and structural alterations: by MRI, regional RV akinesia or dyskinesia or dyssynchronous RV contraction and RV ejection fraction ≤40%, and repolarization abnormalities: inverted T waves in right precordial leads [V1, V2, and V3]); and one minor criterion (>500 ventricular extrasystoles per 24 hours by Holter), and so a diagnosis of ARVD was made. After electrophysiologic study (EPS) the patient received an implantable cardioverter-defibrillator (ICD). This late clinical presentation of ARVD highlights the importance of TTE screening, possibly complemented by MRI. The associated risk of sudden death was assessed by EPS leading to the implantation of an ICD. Genetic association studies should be offered to the offspring of all ARVD patients.
authors.affiliation: Serviço de Endocrinologia, Hospital de Santa Maria/CHLN, Lisboa, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Marçalo
authors.affiliation: Serviço de Endocrinologia, Hospital de Santa Maria/CHLN, Lisboa, Portugal; Departamento de Medicina, Hospital de Santa Maria/CHLN, Faculdade de Medicina de Lisboa, Lisboa, Portugal. Electronic address: luizmfalcao@sapo.pt.
authors.forename: Luiz
authors.initials: L
authors.lastname: Menezes Falcão
mesh_terms: D000368:Aged; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis*; D006801:Humans; D008297:Male
keywords: Arrhythmogenic right ventricular dysplasia; Cardiac electrophysiologic study; Cardioversor‐desfibrilhador implantável; Displasia arritmogénica do ventrículo direito; Ecocardiografia transtorácica; Estudo eletrofisiológico cardíaco; Implantable cardioverter‐defibrillator; Magnetic resonance imaging; Morte súbita cardíaca; Ressonância magnética cardíaca; Sudden cardiac death; Transthoracic echocardiography