Differential Diagnosis for the Provided ECG

The ECG provided suggests a condition affecting the heart's ventricular function, particularly indicating abnormalities in the right ventricle. Based on the information and typical ECG findings, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): This condition is characterized by the replacement of the myocardium in the right ventricle by fatty tissue, leading to abnormal heart rhythms. The ECG often shows T-wave inversion in the right precordial leads (V1-V3), epsilon waves (small deflections at the end of the QRS complex), and sometimes a prolonged QRS duration in the right precordial leads, which aligns with the provided image.

• Other Likely Diagnoses

  • Right Ventricular Outflow Tract Tachycardia (RVOT): This condition involves abnormal electrical activity originating from the right ventricular outflow tract, leading to tachycardia. While the ECG might not specifically point to RVOT without further context (like symptoms or response to maneuvers), it's a consideration given the right ventricular focus.
  • Brugada Syndrome: Characterized by ST elevation in leads V1-V3, this syndrome can mimic some ECG features seen in ARVC, particularly in its early stages or with atypical presentations.

• Do Not Miss Diagnoses

  • Acute Coronary Syndrome (ACS) involving the Right Coronary Artery: Although less common, an ACS affecting the right coronary artery can lead to ischemia or infarction of the right ventricle, presenting with ECG changes that might overlap with those seen in ARVC.
  • Pulmonary Embolism: A large pulmonary embolism can cause acute right ventricular strain, leading to ECG changes including T-wave inversion in the anterior leads, which could be mistaken for ARVC.

• Rare Diagnoses

  • Cardiac Sarcoidosis: This condition involves the infiltration of the heart by granulomas, which can lead to scarring and affect the heart's electrical activity. While it can mimic ARVC in its presentation, it is less common and typically requires additional diagnostic evidence.
  • Chagas Disease: Caused by Trypanosoma cruzi, this disease can lead to chronic cardiomyopathy with ventricular dysfunction and arrhythmias, potentially mimicking ARVC in its late stages, especially in endemic areas.

Each of these diagnoses requires careful consideration of the clinical context, additional diagnostic tests (like echocardiography, cardiac MRI, or genetic testing), and sometimes invasive procedures to confirm the diagnosis and guide management.