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Tahani I, Hattab O, ismaili N, el ouafi N. An atypical case report of an arrhythmogenic cardiomyopathy in a 70-years-old patient with suggestive left ventricular signs. Radiol Case Rep 2024; 19:3102-3111. [PMID: 38770386 PMCID: PMC11103369 DOI: 10.1016/j.radcr.2024.03.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 05/22/2024] Open
Abstract
Arrhythmogenic dysplasia of the right ventricule (ARVC), actually known as arrhythmogenic cardiomyopathy (ACM) is a rare genetic condition caused by the replacement of the normal right ventricular myocardium with fibrofatty tissue. However, 2 other phenotypes affecting the left ventricle were recently discovered. The disease usually appears in patients ranging from 30 to 50 years old; in fact, about 80% of cases occur in young patients <40 years of age. Therefore, it is usually considered in young adults or athletes presenting with a history of syncope, ventricular arrhythmias (VA), and/or sudden cardiac death (SCD). We report an atypical case of a 70-year-old male who was admitted to the hospital for spontaneous ventricular tachycardia (VT) that was reduced by an immediate electric shock, and the paraclinical investigations strongly supported the presence of an almost complete form of the disease with electric signs in favor of possible left ventricular (LV) damage, which makes the case even more interesting.
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Affiliation(s)
- ikram Tahani
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - oumayma Hattab
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - Nabila ismaili
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - Noha el ouafi
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
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2
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Yu B, Poulakos N, Beaulieu-Shearer A, Turgeon PY, Trahan S, Belzile D, Sénéchal M. Young patient presenting with cardiogenic shock and refractory ventricular tachycardia: a case of unsuspected arrhythmogenic cardiomyopathy leading to urgent heart transplantation. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2024; 14:121-127. [PMID: 38764547 PMCID: PMC11101963 DOI: 10.62347/taey9817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/27/2024] [Indexed: 05/21/2024]
Abstract
Arrhythmogenic right ventricular cardiomyopathy is an important differential diagnosis in young patients presenting with palpitations and/or dyspnea and must be appropriately investigated. A 23-year-old man presented with cardiogenic shock and monomorphic ventricular tachycardia. He reported palpitations and progressive dyspnea for more than two years, but those symptoms were attributed to anxiety without any further investigation by his family physician. Investigations after the catastrophic presentation in our center suggested terminal right-sided heart failure with severe hepatic insufficiency and acute kidney injury. The patient benefited from extracorporeal membrane oxygenation, followed by an urgent heart transplant 16 days later after the exclusion of liver cirrhosis. Histopathologic analysis of the explanted heart confirmed arrhythmogenic cardiomyopathy.
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Affiliation(s)
- Benoit Yu
- Faculty of Medicine, Université LavalQuébec, QC, Canada
| | | | | | - Pierre Yves Turgeon
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de QuébecQuébec, QC, Canada
| | - Sylvain Trahan
- Department of Pathology, Institut Universitaire de Cardiologie et de Pneumologie de QuébecQuébec, QC, Canada
| | - David Belzile
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de QuébecQuébec, QC, Canada
| | - Mario Sénéchal
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de QuébecQuébec, QC, Canada
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3
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Phan DP, Tran TV, Le VK, Nguyen TV. Detection of gene mutation in the prognosis of a patient with arrhythmogenic right ventricular cardiomyopathy: a case report. J Med Case Rep 2024; 18:49. [PMID: 38336791 PMCID: PMC10858638 DOI: 10.1186/s13256-023-04326-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 12/18/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC), or more recently known as arrhythmogenic cardiomyopathy (ACM), is an heritable disorder of the myocardium characterized by progressive fibrofatty replacement the heart muscle and risk of ventricular arrhythmias and sudden cardiac death (SCD). We report a case study to demonstrate the role of gene mutation detection in risk stratification for primary prevention of SCD in a young patient diagnosed with ARVC. CASE PRESENTATION A 15-year-old Asian (Vietnamese) male patient with no history of documented tachyarrhythmia or syncope and a family history of potential SCD was admitted due to palpitations. Clinical findings and work-up including cardiac magnetic resonance imaging (MRI) were highly suggestive of ARVC. Gene sequencing was performed for SCD risk stratification, during which PKP2 gene mutation was found. Based on the individualized risk stratification, an ICD was implanted for primary prevention of SCD. At 6 months post ICD implantation, the device detected and successfully delivered an appropriate shock to terminate an episode of potentially fatal ventricular arrhythmia. ICD implantation was therefore proven to be appropriate in this patient. CONCLUSIONS While gene mutations are known to be an important factor in the diagnosis of ARVC according to the 2010 Task Force Criteria and recent clinical guidelines, their role in risk stratification of SCD remains controversial. Our case demonstrated that when used with other clinical factors and family history, this information could be helpful in identifying appropriate indication for ICD implantation.
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Affiliation(s)
- Dinh Phong Phan
- Cardiac Electrocardiogram and Electrophysiology Laboratory, Vietnam National Heart Institute, Bach Mai Hospital, 78 Giai Phong St., Hai Ba Trung, Hanoi, Vietnam.
- Hanoi Medical University, 1 Ton That Tung St., Dong Da, Hanoi, Vietnam.
| | - Tuan Viet Tran
- Cardiac Electrocardiogram and Electrophysiology Laboratory, Vietnam National Heart Institute, Bach Mai Hospital, 78 Giai Phong St., Hai Ba Trung, Hanoi, Vietnam
- Hanoi Medical University, 1 Ton That Tung St., Dong Da, Hanoi, Vietnam
| | - Vo Kien Le
- Cardiac Electrocardiogram and Electrophysiology Laboratory, Vietnam National Heart Institute, Bach Mai Hospital, 78 Giai Phong St., Hai Ba Trung, Hanoi, Vietnam
| | - Tuan Viet Nguyen
- Hanoi Medical University, 1 Ton That Tung St., Dong Da, Hanoi, Vietnam
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Mishra D, Shankar O, Aggarwal V. Varied Presentation of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C): A Case Series. Cureus 2023; 15:e33883. [PMID: 36819412 PMCID: PMC9934937 DOI: 10.7759/cureus.33883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 01/19/2023] Open
Abstract
Arrhythmogenic right ventricular dysplasia (ARVD) is a genetically predisposed form of cardiomyopathy that mainly affects young individuals resulting in fatal ventricular arrhythmias leading to sudden cardiac death. ARVD has 50% of cases that involve both the right ventricle (RV) and left ventricle (LV), but only a small number of cases involve an isolated left ventricle. In this case series, five patients (four males and one female) with a diagnosis of ARVD presented to our center with varied clinical presentations across a wide range of age groups. The MRI of all five cases showed dilated right atrium (RA)/RV with right ventricular free wall dyskinesia. Two-dimensional (2D) MRI showed aneurysmal outpouching with diffuse free wall enhancement. Automated implantable cardioverter defibrillator (AICD) was implanted uneventfully in all five patients, and the patients were discharged with oral medications such as low-dose diuretics, beta-blockers, spironolactone, angiotensin-converting enzymes (ACE) inhibitors, amiodarone, and anxiolytics. Until now, the patients were doing well on follow-up visits. The therapeutic management of patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) has evolved over the years and continues to be an important challenge. To further improve risk stratification and treatment of patients, more information is needed on natural history, long-term prognosis, and risk assessment. Special attention should be focused on the identification of patients who would benefit from implantable cardioverter-defibrillator (ICD) implantation in comparison to pharmacological and other nonpharmacological approaches.
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Affiliation(s)
- Dhananjay Mishra
- Cardiology, Institute of Medical Sciences (IMS) Banaras Hindu University (BHU), Varanasi, IND
| | - Om Shankar
- Cardiology, Institute of Medical Sciences (IMS) Banaras Hindu University (BHU), Varanasi, IND
| | - Vikas Aggarwal
- Cardiology, Institute of Medical Sciences (IMS) Banaras Hindu University (BHU), Varanasi, IND
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5
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Parker LE, Landstrom AP. The clinical utility of pediatric cardiomyopathy genetic testing: From diagnosis to a precision medicine-based approach to care. PROGRESS IN PEDIATRIC CARDIOLOGY 2021; 62. [PMID: 34776723 DOI: 10.1016/j.ppedcard.2021.101413] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Pediatric-onset cardiomyopathies are rare yet cause significant morbidity and mortality in affected children. Genetic testing has a major role in the clinical evaluation of pediatric-onset cardiomyopathies, and identification of a variant in an associated gene can be used to confirm the clinical diagnosis and exclude syndromic causes that may warrant different treatment strategies. Further, risk-predictive testing of first-degree relatives can assess who is at-risk of disease and requires continued clinical follow-up. Aim of Review In this review, we seek to describe the current role of genetic testing in the clinical diagnosis and management of patients and families with the five major cardiomyopathies. Further, we highlight the ongoing development of precision-based approaches to diagnosis, prognosis, and treatment. Key Scientific Concepts of Review Emerging application of genotype-phenotype correlations opens the door for genetics to guide a precision medicine-based approach to prognosis and potentially for therapies. Despite advances in our understanding of the genetic etiology of cardiomyopathy and increased accessibility of clinical genetic testing, not all pediatric cardiomyopathy patients have a clear genetic explanation for their disease. Expanded genomic studies are needed to understand the cause of disease in these patients, improve variant classification and genotype-driven prognostic predictions, and ultimately develop truly disease preventing treatment.
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Affiliation(s)
- Lauren E Parker
- Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, United States
| | - Andrew P Landstrom
- Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, United States.,Department of Cell Biology, Duke University School of Medicine, Durham, NC, United States
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Vahidnezhad H, Youssefian L, Faghankhani M, Mozafari N, Saeidian AH, Niaziorimi F, Abdollahimajd F, Sotoudeh S, Rajabi F, Mirsafaei L, Sani ZA, Liu L, Guy A, Zeinali S, Kariminejad A, Ho RT, McGrath JA, Uitto J. Arrhythmogenic right ventricular cardiomyopathy in patients with biallelic JUP-associated skin fragility. Sci Rep 2020; 10:21622. [PMID: 33303784 PMCID: PMC7729882 DOI: 10.1038/s41598-020-78344-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/09/2020] [Indexed: 12/04/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC), with skin manifestations, has been associated with mutations in JUP encoding plakoglobin. Genotype–phenotype correlations regarding the penetrance of cardiac involvement, and age of onset have not been well established. We examined a cohort of 362 families with skin fragility to screen for genetic mutations with next-generation sequencing-based methods. In two unrelated families, a previously unreported biallelic mutation, JUP: c.201delC; p.Ser68Alafs*92, was disclosed. The consequences of this mutation were determined by expression profiling both at tissue and ultrastructural levels, and the patients were evaluated by cardiac and cutaneous work-up. Whole-transcriptome sequencing by RNA-Seq revealed JUP as the most down-regulated gene among 21 skin fragility-associated genes. Immunofluorescence showed the lack of plakoglobin in the epidermis. Two probands, 2.5 and 22-year-old, with the same homozygous mutation, allowed us to study the cross-sectional progression of cardiac involvements in relation to age. The older patient had anterior T wave inversions, prolonged terminal activation duration (TAD), and RV enlargement by echocardiogram, and together with JUP mutation met definite ARVC diagnosis. The younger patient had no evidence of cardiac disease, but met possible ARVC diagnosis with one major criterion (the JUP mutation). In conclusion, we identified the same biallelic homozygous JUP mutation in two unrelated families with skin fragility, but cardiac findings highlighted age-dependent penetrance of ARVC. Thus, young, phenotypically normal patients with biallelic JUP mutations should be monitored for development of ARVC.
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Affiliation(s)
- Hassan Vahidnezhad
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, 233 S. 10th Street, Suite 450 BLSB, Philadelphia, PA, 19107, USA.,Molecular Medicine Department, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Leila Youssefian
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, 233 S. 10th Street, Suite 450 BLSB, Philadelphia, PA, 19107, USA.,Genetics, Genomics and Cancer Biology PhD Program, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoomeh Faghankhani
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, 233 S. 10th Street, Suite 450 BLSB, Philadelphia, PA, 19107, USA
| | - Nikoo Mozafari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Saeidian
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, 233 S. 10th Street, Suite 450 BLSB, Philadelphia, PA, 19107, USA.,Genetics, Genomics and Cancer Biology PhD Program, Thomas Jefferson University, Philadelphia, PA, USA
| | - Fatemeh Niaziorimi
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, 233 S. 10th Street, Suite 450 BLSB, Philadelphia, PA, 19107, USA
| | | | - Soheila Sotoudeh
- Department of Dermatology, Children's Medical Center, Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Rajabi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Liaosadat Mirsafaei
- Cardiology Ward, Imam Sajjad Hospital, Mazandaran University of Medical Sciences, Mazandaran, Iran
| | - Zahra Alizadeh Sani
- CMR Department, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Lu Liu
- Viapath, St Thomas' Hospital, London, UK
| | - Alyson Guy
- Viapath, St Thomas' Hospital, London, UK
| | - Sirous Zeinali
- Molecular Medicine Department, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran.,Kawsar Human Genetics Research Center, Tehran, Iran
| | | | - Reginald T Ho
- Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - John A McGrath
- St John's Institute of Dermatology, King's College London, Guy's Campus, London, UK
| | - Jouni Uitto
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA. .,Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, 233 S. 10th Street, Suite 450 BLSB, Philadelphia, PA, 19107, USA.
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7
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Mushtaque RS, Mushtaque R, Baloch S, Idrees M, Bhatti H. Clinical Manifestations and Diagnostic Approach to Arrhythmogenic Right Ventricular Cardiomyopathy - A Case Report and Literature Review. Cureus 2020; 12:e11429. [PMID: 33324513 PMCID: PMC7732734 DOI: 10.7759/cureus.11429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare inherited disorder, which is characterized by fibrofatty degeneration of cardiac muscles mainly in the right ventricular myocardium. It may cause tachyarrhythmias or right-heart failure or may cause sudden death, especially in young athletes. In our case report, we present a case of young age male patient who presented at a local community hospital with the complaint of atypical chest pain, palpitations, and vomiting and sustained ventricular tachycardia (VT) on electrocardiograph (ECG) showing sustained VT, left bundle branch morphology with the superior axis. The normal sinus rhythm was achieved after multiple direct current (DC) cardioversion attempts, and he was referred to our tertiary care hospital. Later ECG demonstrated epsilon waves and T wave inversion in V1 to V4 and right bundle branch block (RBBB) morphology. The echocardiography showed a severely dilated right ventricle with dysfunction and right ventricle ventricular apical aneurysm. The definitive diagnosis of ARVC was made as per Revised Task Force Criteria 2010, and the electrophysiology review suggested implantable cardiac defibrillator (ICD) device placement. The patient successfully received a dual-chamber ICD device, and he remained asymptomatic.
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Affiliation(s)
- Raja S Mushtaque
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Rabia Mushtaque
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Shahbano Baloch
- Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
| | | | - Haseeb Bhatti
- Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
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