SAQ 463 – Cardiology – ARVC ECG pattern after palpitations
Model Answer
Cardiology – ARVC ECG pattern after palpitations.
a. ECG interpretation
- Sinus rhythm with features concerning for arrhythmogenic right ventricular cardiomyopathy/dysplasia.
- T-wave inversion in V1-V3 or beyond without right bundle branch block.
- Possible epsilon wave or terminal activation delay in the right precordial leads.
- Localised right-precordial QRS widening/prolonged S-wave upstroke.
- Relevant negatives: no STEMI/acute ischaemic pattern and no prolonged QT or extreme axis if not present.
b. Differential diagnoses
- Arrhythmogenic right ventricular cardiomyopathy/dysplasia.
- Idiopathic right ventricular outflow tract tachycardia.
- Other ventricular tachycardia or cardiomyopathy causing ventricular ectopy/palpitations.
- Brugada pattern or myocarditis may be considered if the ECG morphology supports it.
c. Investigations
| Investigation | Justification |
|---|---|
| Repeat 12-lead ECG and expert cardiology review | Confirms persistent diagnostic features and excludes dynamic ischaemia or lead misplacement. |
| Holter/event monitor | Detects ventricular ectopy, non-sustained VT or correlation with symptoms. |
| Echocardiography | Assesses right ventricular size, function and structural disease. |
| Cardiac MRI | Best non-invasive assessment for RV regional wall motion abnormality and fibro-fatty replacement. |
| Exercise testing | May provoke ventricular arrhythmia and assesses symptom/exercise relationship. |
| Genetic/family screening or electrophysiology testing | Assists diagnosis and sudden-death risk stratification when specialist-led. |
Comments are closed for this SAQ.