A 20-Year-Old Man Develops Substernal Chest Pain and Palpitations, Followed

A 20-year-old man develops substernal chest pain and palpitations, followed by brief syncope while playing soccer.  The patient is rushed to the emergency department where he reports feeling fine.  He describes previous episodes of "chest pressure" while overexerting himself, after which he needs to stop and rest.  He has had no previous episodes of syncope.  Medical history is unremarkable.  The patient does not use tobacco, alcohol, or illicit drugs.  There is no family history of coronary heart disease or sudden death.  Blood pressure is 122/78 mm Hg and pulse is 78/min.  Cardiac examination reveals no murmurs in both the supine and standing positions.  ECG shows normal sinus rhythm with a rate of 72/min.  No ST-segment or T-wave abnormalities are present.  The QTc interval is 410 msec.  The patient is recommended to avoid exercise until he can undergo further workup, but 2 days later he collapses and dies while jogging.  Which of the following is the most likely diagnosis?

A) Anomalous coronary artery
B) Brugada syndrome
C) Congenital long QT syndrome
D) Hypertrophic cardiomyopathy
E) Wolff-Parkinson-White syndrome

Correct Answer:

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