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A Teenager With Palpitations

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A young man nearing the end of his second decade with no significant medical history presented to the emergency department with a 1-day history of intermittent palpitations and chest pain associated with shortness of breath. On presentation, the patient appeared anxious with a heart rate of 101 beats per minute, respiratory rate of 20 breaths per minute, blood pressure of 151/79 mm Hg, and pulse oximetry of 96% in room air. His cardiopulmonary examination results, complete blood cell count, basic metabolic panel, and cardiac troponins were all within normal limits. His electrocardiogram on presentation and echocardiogram are shown in Figure 1 and the Video.

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A young man nearing the end of his second decade with no significant medical history presented to the emergency department with a 1-day history of intermittent palpitations and chest pain associated with shortness of breath. On presentation, the patient appeared anxious with a heart rate of 101 beats per minute, respiratory rate of 20 breaths per minute, blood pressure of 151/79 mm Hg, and pulse oximetry of 96% in room air. His cardiopulmonary examination results, complete blood cell count, basic metabolic panel, and cardiac troponins were all within normal limits. His electrocardiogram on presentation and echocardiogram are shown in Figure 1 and the Video.

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Article Information

Corresponding Author: Hitesh Raheja, MD, Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY 11219 (hiteshraheja88@gmail.com).

Published Online: October 13, 2021. doi:10.1001/jamacardio.2021.4017

Conflict of Interest Disclosures: None reported.

References
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Corrado  D , Link  MS , Calkins  H .  Arrhythmogenic right ventricular cardiomyopathy.   N Engl J Med. 2017;376(1):61-72. doi:10.1056/NEJMra1509267PubMedGoogle ScholarCrossref
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Peters  S , Trümmel  M , Meyners  W .  Prevalence of right ventricular dysplasia-cardiomyopathy in a non-referral hospital.   Int J Cardiol. 2004;97(3):499-501. doi:10.1016/j.ijcard.2003.10.037PubMedGoogle ScholarCrossref
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Awad  MM , Calkins  H , Judge  DP .  Mechanisms of disease.   Nat Clin Pract Cardiovasc Med. 2008;5(5):258-267. doi:10.1038/ncpcardio1182PubMedGoogle ScholarCrossref
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Marcus  FI , Fontaine  GH , Guiraudon  G ,  et al.  Right ventricular dysplasia.   Circulation. 1982;65(2):384-398. doi:10.1161/01.CIR.65.2.384PubMedGoogle ScholarCrossref
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Gandjbakhch  E , Redheuil  A , Pousset  F , Charron  P , Frank  R .  Clinical diagnosis, imaging, and genetics of arrhythmogenic right ventricular cardiomyopathy/dysplasia.   J Am Coll Cardiol. 2018;72(7):784-804. doi:10.1016/j.jacc.2018.05.065PubMedGoogle ScholarCrossref
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Marcus  FI , McKenna  WJ , Sherrill  D ,  et al.  Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia.   Circulation. 2010;121(13):1533-1541. doi:10.1161/CIRCULATIONAHA.108.840827PubMedGoogle ScholarCrossref
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Corrado  D , Wichter  T , Link  MS ,  et al.  Treatment of arrhythmogenic right ventricular cardiomyopathy/dysplasia.   Eur Heart J. 2015;36(46):3227-3237. doi:10.1161/CIRCULATIONAHA.115.017944PubMedGoogle Scholar
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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