Aortic Dissection (Imaging) — EECC MCQ

Correct answer: C — Exercise-induced catecholaminergic polymorphic ventricular tachycardia

The best answer is “Exercise-induced catecholaminergic polymorphic ventricular tachycardia”. Adrenergically triggered bidirectional or polymorphic ventricular tachycardia in a young person with a normal resting ECG and structurally normal heart is the characteristic CPVT phenotype. “Arrhythmogenic right-ventricular cardiomyopathy with exertional arrhythmia” is less appropriate because arrhythmogenic cardiomyopathy usually provides structural, ECG or scar evidence rather than this classic exercise sequence “Brugada syndrome with exercise-induced type-1 ECG” is less appropriate because Brugada syndrome is defined by a characteristic right-precordial ECG pattern and is not identified by bidirectional exercise VT “Long-QT syndrome with pause-dependent torsade de pointes” is less appropriate because long-QT torsade occurs in the setting of QT prolongation and is not characteristically bidirectional with progressive exercise “Typical AV-nodal re-entrant tachycardia with aberrant conduction” is less appropriate because AV-nodal re-entry is supraventricular and does not explain bidirectional ventricular activation

Reference: 2022 ESC Guidelines for ventricular arrhythmias and sudden cardiac death. https://academic.oup.com/eurheartj/article/43/40/3997/6675633