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A 19-year-old Asian male, with family history of unexplained sudden death, was referred because of palpitations and breathlessness. His cardiovascular examination was within normal limits. Baseline ECG (see online supplementary image) showed incomplete right bundle-branch block with right axis deviation and early repolarisation pattern. A previous cardiac magnetic resonance (CMR) reported a dyskinetic right ventricle with increased indexed end-diastolic volume (112 mL/m2, which is greater than the normal cut-off of 110 mL/m2 for male). The patient was therefore advised to avoid endurance sports and was referred for a follow-up CMR for re-evaluation of the right ventricular size and function. The follow-up CMR images are shown in figure 1: on the repeat evaluation …
Contributors AB, AGD and CBD conceived the initial idea. AB drafted the initial manuscript. AB, AGD and CBD revised and approved the final manuscript.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Correction notice Figure 2 has been modified since this image challenge was first published online.