Palpitations

• 37 year old male
• Transported by EMS from the airport with 2 hours of "my heart is racing" while on a flight

RAD

• Chronic Pulmonary HTN (RVH)
• Acute Pulmonary HTN (PE)
• Na+ Channel Blockage
• LPFB
• Dextrocardia
• Lateral MI (large Q-Wave in I)
• Ventricular Tachycardia
• Hyperkalemia
• Lead misplaced

Arrhythmogenic right ventricular dysplasia (ARVD)

• "Fibrous or fibro-fatty replacement of myocardium in the inflow tract, outflow tract, and/or apex of the RV" (UTDOL)
• Produces RV dilation and dysfunction
• Prevalence of 1:2000 to 1:5000
• Mean age of diagnosis is 30
  
• May be familial or sporadic - mutations in genes encoding cardiac proteins
• Can be found in some diseases or syndromes (eg, Naxos disease, Carvajal syndrome)

Symptoms

• RV dilation and dysfunction can predispose to arrhythmias
• PVC, SVT, AFib, VT, VF -> Sudden Cardiac Death
• May be precipitated by exercise
• Dysplasia may also spread to LV
  

Diagnosis

• EKG Findings (may evolve over years as RV remodels)
• QRS Prolongation (more seen in lead V1 over RV versus lead V6) - delayed RV activation
• iRBBB or RBBB - damage to terminal Purkinje fibers
• Prolonged S wave upstroke
• Epsilon wave (distinct wave between end of QRS and onset of T-wave) in right precordial leads
  
• Inferior or right precordial (V1, V2, V3) TWI
• RAD
  

• Echocardiogram
• Increased RV dimensions
• Decreased RV systolic function
• RV morphologic changes
• Cardiac MRI

Treatment

• Limit physical activity
• Beta-blockers
• Anti-arrhythmia medications (i.e. sotalol, amiodarone)
• Anti-coagulants
  
• ICD
  

Reference: utdol.com
Reference: http://www.heartpearls.com/tag/epsilon-wave
Reference: http://www.metealpaslan.com/ecg/arvden.htm
Reference: http://www.escardio.org/communities/councils/ccp/e-journal/volume7/Pages/vol7n6.aspx#.U9E_NVbBU08
Reference: http://limpeter-mriblog.blogspot.com/2009_12_01_archive.html