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Arrhythmogenic MVP — RACP Adult Medicine MCQ

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HardCardiologyArrhythmogenic MVPRACP Adult Medicine

A 42-year-old woman with known mitral valve prolapse develops palpitations. Holter monitor shows runs of non-sustained ventricular tachycardia. Echocardiography shows myxomatous mitral valve with moderate mitral regurgitation and LVEF 58%. Cardiac MRI shows fibrosis of the papillary muscles and inferolateral wall. What does the fibrosis pattern suggest?

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Correct answer: C — Myocarditis

Arrhythmogenic MVP (AMVP or 'malignant MVP') is increasingly recognised as a cause of sudden cardiac death, particularly in young women with bileaflet MVP. Characteristic features include: complex ventricular arrhythmias (PVCs/NSVT with RBBB-superior axis morphology arising from the papillary muscles/inferolateral wall), fibrosis on cardiac MRI (papillary muscles, inferolateral wall), and T-wave inversion in inferior leads. Risk stratification with cardiac MRI and ambulatory monitoring guides management. ICD implantation is considered for high-risk patients with sustained VT/VF.

Reference: eTG – 2025 – Cardiovascular; ESC – 2022 – Ventricular Arrhythmia Guidelines