Thirty year old male was resuscitated from cardiac arrest. His temperature was 37 degrees centigrade and serum potassium was 4.5 mEq/litre. ECG showed an abnormal wave at the end of the QRS complex. He is likely to have:
Correct answer: c) Arrhythmogenic right ventricular dysplasia
The wave at the end of the QRS is likely to be Epsilon wave. It is sometimes called ‘post excitation’ by analogy with the delta wave seen at the beginning of the QRS in pre-excitation. Hypothermia and hypokalemia can cause cardiac arrest, which are excluded from the data given. Osborne wave in hypothermia is also seen at the end of the QRS complex.
Hypertrophic obstructive cardiomyopathy would show left ventricular hypertrophy with strain pattern and sometimes giant T wave inversions. Long QT syndrome would not affect the QRS complex.
Acute myocardial infarction should have shown other features on the ECG.
Other possibilities to be considered are the J wave syndromes like the malignant variety of early repolarization syndrome.
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