37-year-old male smoker of 60 cigarettes/day since his adolescence, hospitalized for recurrent syncope.
On admission, monoform VT was recorded with a frequency of 233 bpm on a monitor line, which spontaneously converted to sinus rhythm.
The patient was an occasional cocaine user up to 3 years before admission.
Have angina or dyspnea
The post-conversion ECG to sinus rhythm showed T waves (-) in the precordial leads and the inferior wall.
Troponin I reached a maximum value of 0.8 ng/ml [VN < 0.4 ng/ml].
An echocardiogram revealed a slight increase in the LV internal diameters, apical and lateroapical dyskinesia with a slightly decreased global systolic function [FE 45%, Simpson].
RV evaluation showed no abnormalities.
With the presumptive diagnosis of coronary artery disease, an angiographic study showed normal coronary arteries was performed.
To advance in the diagnostic study, CR was requested.
Images with diminished function echo-gradient sequences and lower short axis showed RV dilatation [122/ASC and severe global dyspnoea (such as decreased lateral wall parietal thickness), microaneurysms (19%).
At the same time, there was a slight increase in the internal diameters of the LV with moderate decrease in its global systolic function (EF 38%), two areas with dyskinesia in the apical region adjacent with thinning of the myocardial wall blue heref.
On T1-weighted axial images, the presence of fat subepicardial layer in the RV lateral wall and the LV lateral and apex wall (green leaves) are observed.
In turn, the image of four threats with investment sequences-recovery to evaluate after the administration of intravenous gadolinium showed extensive area of fibrosis (late enhancement) in the RV wall.
The findings described are diagnostic for RVAD with LV involvement, in the presence of three major diagnostic criteria: documented systolic volume waves in right precordial leads (V1 to V6) in an individual > 14 years old with no right bundle branch block.
Patient management included ICD implantation.
