Aritmogena displazija desne komore
Da li gledamo epsilon talas u EKG-u?

Dr Milica Stefanović

Aritmogena displazija/kardiomiopatija desne komore (ARVD/C) je primarno oboljenje miokarda u kome je normalno tkivo miokarda zamenjeno fibrozno-masnim. Obično zahvata desnu komoru. Posle hipertrofične kardiomiopatije ARVD se smatra najčešćim uzrokom iznenadne smrti mladih, a pogotovo sportista. Pacijenti sa ARVD su najčešće muškarci mlađi od 35 godina, koji se žale na bol u grudima i imaju visoku srčanu frekvenciju. U nekim slučajevima, prvi simptom je nažalost iznenadna srčana smrt. Simptomi ove bolesti su veoma raznovrsni, ali se najčešće javljaju palpitacije, presinkopa i sinkopa. Fizikalni pregled je u oko 50% bolesnika normalan. Kod one druge polovine može se naći udvojen drugi srčani ton, prisutni su S3 i S4, ređe šum. Preko 50% ovih bolesnika pokazuje EKG abnormalnosti: invertovan T talas u desnim prekordijalnim odvodima (V2 iV3) u odsustvu bloka desne grane, epsilon talas, produžen  QRS kompleks (>110 ms) u V1 i V2, inkompletan blok desne grane, ventrikularna tahikardija (sustained and non-sustained) sa blokom leve grane, česte ventrikularne ekstrasistole (više od 1000/24h). Dalja dijagnostika podrazumeva upotrebu drugih neinvazivnih dijagnostičkih procedura, kao što su Holter monitoring, test opterećenjem, ehokardiografija i magnetna rezonanca srca, ali i  invazivne u vidu ventrikularne angiografije, elektrofiziološke testove i endomiokardijalne biopsije. Posto je relativno čest uzrok iznenadne smrti sportista, prema  evropskim preporukama za učestvovanje u rekreativnom i takmičarskom sportu, svi oni sa kliničkom dijagnozom ove bolesti ne treba da se bave takmičarskim sportom.

Arrhythmogenic right ventricular dysplasia.
Are we looking for epsilon wave on ECG?
Dr. Milica Stefanovic

Arrhythmogenic right ventricular dysplasia (ARVD) is a disorder in which normal myocardium is replaced by fibrofatty tissue. This disorder usually involves the right ventricle. After hypertrophic heart disease, it is  considred as one of the main cause of sudden cardiac death in young  athletes. Patients with ARVD are usually men younger than 35 years who complain of chest pain or rapid heart rate. In some cases, sudden cardiac arrest following physical exertion such as participation in sports may be the first presentation. Palpitations, fatigue, and syncope appear to be the most common symptoms. The physical examination is normal in at least 50 percent of patients with ARVD. However, patients could show a widely split S2.  A murmur or S3 or S4 heart sound may be present. Over the fifty percent of persons with ARVD will have characteristic findings on a resting electrocardiogram. These findings include: inverted T waves in the anterior precordial leads, epsilon waves, localized prolongation of the QRS complex in leads V1 and V2 , incomplete or complete RBBB, sustained or nonsustaincd left bundle branch block-type VT, frequent ventricutar extrasystoles (> 1000/24 h). Further confirmation of the diagnosis includes noninvasive studies, such as echocardiography, exercise stress testing and magnetic resonance imaging of the heart, and invasive testing includes right ventricular angiography,  electrophysiologic studies and endomyocardial biopsy. Regarded as one of the most commom cause of death in young atlethes, european recommendations says that the one with clinical diagnosis of ARVD should be excluded from the most competitive sports.

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