A Latin American Immigrant With Cardiac Arrest
As part of National Minority Health Month, and in recognition of World Chagas Day on April 14th, the ACC is offering a collection of educational content to bring awareness to Chagas disease, including a Certified Patient Case and a poll. See all the offerings on the Arrhythmias and Clinical EP Clinical Topic Collection. For patient resources, check out CardioSmart's Kissing Bugs page.
A 44-year-old El Salvadorian immigrant with no applicable medical history suffered a ventricular fibrillation arrest while lifting a bag of potatoes. A post-arrest electrocardiogram showed atrial fibrillation with a slow ventricular response, right bundle branch block with left anterior fascicular block, and a variable QT interval (on one occasion 554 msec). No ST-segment elevation was noted. An echocardiogram post-arrest showed normal left ventricular size, ejection fraction of 20% with worse function of the basal inferior/inferolateral segments, right ventricular dilatation, and severe hypokinesis. Troponin was 0.078 peaking at 6.1. An electrolyte panel was normal. A coronary angiogram was performed, and no obstructive coronary artery disease was noted.
What would be the single best test to diagnose his arrhythmogenic condition?