A 17-year-old female was admitted to the coronary care unit after an aborted sudden cardiac death. She collapsed suddenly after awakening, was found in ventricular fibrillation (VF), and was successfully defibrillated. She had a past history of recurrent fainting spells and a family history of sudden death in her sister at the age of 20.
What is the most likely diagnosis?
A. Hypertrophic cardiomyopathy (HCM)
B. Brugada syndrome
C. Idiopathic ventricular fibrillation
D. Right ventricular outflow tract (RVOT) tachycardia
E. Long QT syndrome
Answer:
E. Long QT syndrome
Explanation:
-
Key clues:
-
Teenage patient with recurrent syncope.
-
Family history of sudden cardiac death at a young age.
-
Event occurred during sudden arousal (telephone ringing, awakening) → a classic trigger for arrhythmia in congenital Long QT syndrome (especially LQT2 subtype).
-
-
Other options:
-
HCM → may cause sudden death but usually exertional, often with murmur/LVH signs.
-
Brugada syndrome → typically in young men, ECG pattern with coved ST elevation in V1–V3.
-
Idiopathic VF → diagnosis of exclusion, no family history or syncope episodes.
-
RVOT tachycardia → benign, monomorphic VT, not associated with family history of SCD.
-
📌 Key Point:
-
Long QT syndrome → syncope or VF triggered by exercise, emotional stress, or sudden auditory stimuli, with strong family history of SCD.
ليست هناك تعليقات:
إرسال تعليق