CBC, CMP, TSH performed at initial work up were all within normal limits.
CTA: no acute cardiopulmonary process. No evidence of PE.
Holter monitor: 742 PVCs in 24 hours; 6 beats of NSVT (unclear morphology) vs SVT with aberrancy.
Exercise Treadmill Stress ECG: No ischemic changes or dysrhythmias; PVCs from the inferior RV noted.
Case Photo #1 Case Photo #2RV mildly enlarged. The diaphragmatic/inferior RV wall and RV apex are focally dyskinetic. There is delayed and hyperenhancement of the inferior and apical RV walls. This is compatible with fibrofatty infiltration of the RV.
Signal Average ECG: Normal
Genetic testing: Pathogenic mutation in PKP2 R79X (Plakophilin 2)
Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.