Hour 0: Emergency room presentation | Administration of metoprolol, amiodarone, and lidocaine for ventricular tachycardia (VT). |
Hour 3 | Sudden cardiac arrest from ventricular fibrillation with cardiopulmonary resuscitation (CPR) and return of spontaneous circulation. |
Day 1 | Transthoracic echocardiogram (TTE) demonstrated both global and regional depressed left ventricular (LV) function with ejection fraction of 45%. Late gadolinium enhancement seen on cardiac magnetic resonance imaging in sub-epicardial regions of the LV. |
Day 2 | No further VT. Lidocaine infusion stopped. |
Day 3 | Endomyocardial biopsy showed lymphocytic myocarditis and scattered areas of myocyte hypertrophy and fibrosis. Totally subcutaneous implantable cardioverter-defibrillator (S-ICD) implanted for secondary prevention. |
Day 4 | Discharge from hospital on oral amiodarone and metoprolol. |
Month 3 | Repeat TTE showed recovery of LV function with ejection fraction of 54%. Cardiomyopathy gene panel revealed DSP truncation variant p. R1951X. This variant was also identified in the patient’s mother, who had a known cardiomyopathy. |
Month 12 | No ventricular arrhythmias recorded on S-ICD; no new symptoms. Patient continues on metoprolol and amiodarone. |