22-year-old female competitive tennis player was referred for cardiovascular screening. She was asymptomatic from a cardiovascular perspective and trained during three sessions per week for a duration of approximately 5-6 hours.
There is a family history of sudden cardiac death (father died suddenly at the age of 35 years). Clinical examination demonstrated a heart rate of 40bpm regular with a BP of 110/60mmHg. Cardiac auscultation revealed dual heart sounds with no additional murmurs.
- The 12-lead electrocardiogram (ECG) is shown in Figure 1
- Echocardiography was performed (Videos 1 & 2)
- On exercise treadmill testing, there was 1 premature ventricular contraction (PVC) at peak of exercise and 3 PVCs during the early recovery with 2 different morphologies (RBBB, wide QRS+superior axis and LBBB+inferior axis), shown in Figure 2
- A 24-hour Holter ECG revealed isolated ventricular extra-systoles (54/24 h, same morphologies of PVCs seen at treadmill test)
Figure 1. Resting ECG
Video 1. Echocardiography, parasternal long axis view
Video 2. Echocardiography, subcostal view
Figure 2. ECG during exercise stress test
Showing premature ventricular complexes (RBBB, wide QRS+superior axis):
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