PMC6877905_01
Serial ECGs: initial ECG performed at age 33 (a) with sinus rhythm and prolonged PR interval. Surveillance ECG performed one year later at age 34 (b) with slowing of the sinus rate and prolonged PR interval. First ECG during pregnancy performed at age 35 (c) showed new sinus bradycardia with competing junctional rhythm, occasional PVCs (RBS axis), and lower voltage QRS and poor R wave progression. Paper speed and amplification: 25 mm/s and 1 mV/10 mm.
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Her electrocardiogram (ECG) was notable for sinus rhythm at 71 beats per minute with a PR interval of 214 milliseconds and was otherwise unremarkable (Figure 1(a)). R wave progression:all of which were new (Figure 1(c)). Review of her family history revealed that her father died at age 47 while awaiting heart transplantation for presumed end-stage ischemic cardiomyopathy.
Mobile cardiac outpatient telemetry: frequent multifocal ventricular arrhythmias.
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Given these findings, a 30-day ambulatory arrhythmia monitor was ordered, and within the first two weeks, sinus node dysfunction and frequent multifocal ventricular arrhythmias were captured (Figure 2).
Pedigree: numbers below symbols denote current age or age at death. + denotes normal allele.
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Her three-generation family history was notable for cardiomyopathy in her father and heart issues in her paternal grandfather (Figure 3).