A woman in her 30s with active bulimia was brought by ambulance to the emergency department after a syncopal event that followed 1 hour of palpitations and intermittent lightheadedness. When emergency responders arrived, the patient was responsive but groggy. An electrocardiogram (ECG) in the field demonstrated a regular wide complex tachycardia. En route to the hospital, 6 mg of adenosine followed by 12 mg of adenosine were administered intravenously, without a change in her rhythm.
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Arrhythmogenic right ventricular cardiomyopathy
C. Cardiac magnetic resonance imaging
The initial and postcardioversion ECGs raise suspicion for an underlying structural abnormality, and further characterization with additional imaging is recommended. The initial ECG (Figure, A) shows a regular wide complex tachycardia with a rate of 225 beats per minute. The inferior axis and left bundle-branch block pattern in the precordial leads with late transition (V5) are consistent with ventricular tachycardia (VT) originating in the right ventricular outflow tract. Once the rhythm was determined to be VT, the initial differential diagnosis for this relatively young woman with electrolyte abnormalities, no cardiac history, and no family history of sudden cardiac death included both structural and nonstructural processes.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Paul J. Marano, MD, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143 (email@example.com).
Published Online: December 26, 2019. doi:10.1001/jamacardio.2019.4838
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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