Cardiac Magnetic Resonance (CMR) Image in a Woman With Bulimia and Wide Complex Tachycardia

A woman in her 30s with bulimia developed ventricular tachycardia with syncope. After stabilization and repletion of electrolytes, electrocardiography showed multiform ventricular complexes and repolarization abnormalities. She underwent imaging to identify structural abnormalities that might underlie her arrhythmia, and the cardiac magnetic resonance imaging (CMR) study illustrated here showed borderline reduced right ventricular (RV) ejection fraction (47%), borderline increased RV end-diastolic volume, and dyskinesis of the base of the RV. The findings of RV dyskinesia and mildly depressed RV ejection fraction on CMR along with the presenting arrhythmia and electrocardiography repolarization abnormalities met Revised Task Force Criteria for the diagnosis of arrhythmogenic RV cardiomyopathy (1 major + 2 minor criteria), a genetic form of nonischemic cardiomyopathy manifest as ventricular wall motion abnormality caused by fibrofatty replacement of myocardium. Click the article link for a complete case discussion and images of her electrocardiograms.