A 68-year-old man with a history of hypertension and left ventricular hypertrophy presents to the emergency department after experiencing syncope during morning jogging. His wife reports he collapsed without warning and recovered consciousness within 30 seconds. Vital signs: BP 148/92 mmHg, HR 78 bpm (currently regular), RR 16, O2 sat 98% RA. Physical examination reveals a regular pulse at present and a grade II/VI systolic ejection murmur at the left sternal border. A 12-lead ECG is obtained (see below). The QTc interval measures 520 ms (normal <450 ms in males). Troponin I is negative. An echocardiogram shows mild concentric left ventricular hypertrophy with preserved ejection fraction. During continuous cardiac monitoring in the ICU, the patient experiences an episode of rapid polymorphic ventricular tachycardia with a characteristic appearance of the QRS complexes appearing to rotate around the isoelectric line before spontaneously terminating. Which of the following is the most likely diagnosis?

  1. A)Brugada syndrome with fever-triggered ventricular fibrillation
  2. B)Long QT syndrome with torsades de pointesGABARITO
  3. C)Hypertrophic cardiomyopathy with exercise-induced ventricular tachycardia
  4. D)Early repolarization pattern with idiopathic ventricular fibrillation
  5. E)Catecholaminergic polymorphic ventricular tachycardia triggered by exercise

Explicação

The clinical presentation is classic for Long QT syndrome with torsades de pointes: (1) syncope during exertion in a middle-aged patient; (2) prolonged QTc interval (520 ms) on baseline ECG; (3) documented polymorphic ventricular tachycardia with the character... Ver explicação completa e trilha adaptativa →

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