A 38-year old man with asymptomatic nonobstructive hypertrophic cardiomyopathy, detected during family screening, attended the clinic for a prognostic exercise test. During the third stage of the Bruce protocol, he showed wide complex tachyarrhythmia as shown in the Figure 1, with no clinical or hemodynamic deterioration. The tachyarrhythmia resolved on suspending the test.
What is the diagnosis?
- 1.
This is a ventricular tachycardia, as it meets the Brugada morphological criteria (monophasic R complex in V1 and R<S in V6) and marked right deviation of the QRS axis is present.
- 2.
This is an aberrantly conducted supraventricular tachycardia, given that it does not meet any criteria of the Vereckei algorithm.
- 3.
This is probably a ventricular tachycardia given the clinical context of nonobstructive hypertrophic cardiomyopathy; no further study is required.
- 4.
This is probably an aberrantly conducted supraventricular tachycardia, but definitive diagnosis is not possible with electrocardiographic study, as electrophysiological study would be required for confirmation.
Submit your answer to http://www.revespcardiol.org/en/electroreto/72/11. The answer will be published in the next issue (December 2019). #RetoECG.