AK: 25 year old Caucasian woman
- Extensive work up for recurrent syncope and exertional chest pain
- 5 episodes over last 2 months
- No prodrome or seizure activity
- Somewhat related to exercise or sitting-to-standing
- Family History: one cousin died (cardiac arrest) at age of 27; uncle died at age of 30, unknown cause
- Transthoracic echo: normal RV and LV function; normal valves; LVEF: 65%
- Treadmill stress echo: 11 METS exercise capacity; no arrhythmia, no ST-T abnormalities; normal wall motion
- 30 day event monitor: one 11 beat irregular ventricular tachycardia;
- CT angiogram: normal coronary arteries; Ca2+ score: ‘0’
Note: Exercise capacity is reported in terms of estimated metabolic equivalents of task (METs). The MET unit reflects the resting volume oxygen consumption per minute (VO2) for a 70-kg, 40-year-old man, with 1 MET equivalent to 3.5 mL/min/kg of body weight.
- Which is the most probable clinical diagnosis? Why?
- What are the appropriate steps for the diagnosis?