JACC. Case reports · 2026
Left-Dominant Arrhythmogenic Cardiomyopathy in a Young Athlete: Silent Danger on the Pitch.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Esteves Sofia, Cazeiro Daniel Inácio, Guimarães Tatiana, Agostinho João R, Abecasis João, Pereira da Silva Tiago, Ramos Sância, Pinto Fausto J, Cardim Nuno, Plácido Rui
Аннотация
BACKGROUND: Arrhythmogenic left ventricular cardiomyopathy (ALVC) may present with a myocarditis-like inflammatory "hot phase" and carries the risk of ventricular arrhythmias.
CASE SUMMARY: A 21-year-old athlete presented with hemifacial and arm paresthesia and chest discomfort. He had parietal ischemic lesions, elevated high-sensitivity I troponin, left ventricle (LV) dilation, apical hypokinesia, apical thrombus, and multifocal nonischemic late gadolinium enhancement with edema. A cardioembolic stroke due to myocarditis with an LV thrombus was assumed. However, he had progressive LV remodeling with persistent late gadolinium enhancement. Endomyocardial biopsy showed low-grade inflammation. Genetic testing identified a pathogenic MYBPC3 variant. The patient declined exercise restriction and experienced exercise-triggered ventricular fibrillation. A subcutaneous implantable cardioverter-defibrillator was inserted, and he remained asymptomatic.
DISCUSSION: The presentation and longitudinal course supported ALVC rather than myocarditis.
TAKE-HOME MESSAGES: ALVC can mimic myocarditis and may be unmasked by exercise exposure. Serial cardiac magnetic resonance, endomyocardial biopsy, and genetic testing can confirm the diagnosis.
CASE SUMMARY: A 21-year-old athlete presented with hemifacial and arm paresthesia and chest discomfort. He had parietal ischemic lesions, elevated high-sensitivity I troponin, left ventricle (LV) dilation, apical hypokinesia, apical thrombus, and multifocal nonischemic late gadolinium enhancement with edema. A cardioembolic stroke due to myocarditis with an LV thrombus was assumed. However, he had progressive LV remodeling with persistent late gadolinium enhancement. Endomyocardial biopsy showed low-grade inflammation. Genetic testing identified a pathogenic MYBPC3 variant. The patient declined exercise restriction and experienced exercise-triggered ventricular fibrillation. A subcutaneous implantable cardioverter-defibrillator was inserted, and he remained asymptomatic.
DISCUSSION: The presentation and longitudinal course supported ALVC rather than myocarditis.
TAKE-HOME MESSAGES: ALVC can mimic myocarditis and may be unmasked by exercise exposure. Serial cardiac magnetic resonance, endomyocardial biopsy, and genetic testing can confirm the diagnosis.