Troponin-I elevation in a young man with arrhythmogenic right ventricular dysplasia/cardiomyopathy

Area of Science:

• Cardiology
• Electrophysiology
• Genetics

Background:

• Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a genetic heart muscle disease.
• Ventricular arrhythmias are common in ARVD/C and ischemic heart disease.
• Elevated cardiac enzymes, such as troponin-I, typically indicate myocardial injury, often from coronary artery disease.

Observation:

• A 29-year-old male patient with diagnosed ARVD/C experienced recurrent symptomatic ventricular tachycardia.
• The patient's ventricular tachycardia episodes were terminated by implantable cardioverter defibrillator (ICD) discharges.
• Phasic elevations in troponin-I levels were observed, prompting multiple diagnostic coronary angiograms.

Findings:

• All coronary angiograms performed on the patient were normal, ruling out significant coronary artery disease.
• The patient's ventricular arrhythmias were successfully managed with radiofrequency ablation.
• This case demonstrates that ARVD/C can lead to elevated cardiac enzymes in the absence of obstructive coronary artery disease.

Implications:

• ARVD/C should be considered in the differential diagnosis of elevated cardiac enzymes, especially in younger patients with ventricular arrhythmias.
• Diagnostic strategies for elevated troponin should include evaluation for cardiomyopathies like ARVD/C.
• Accurate diagnosis and targeted treatment, such as radiofrequency ablation, are crucial for managing ARVD/C patients with ventricular arrhythmias and enzyme elevations.