A 19-year-old male footballer survives cardiac arrest during a match. ECG shows epsilon waves in leads V1 to V3 with T-wave inversions over the same leads. MRI demonstrates right ventricular dilation with regional wall thinning. Histology of the myocardium would most likely show:

• A Myofiber disarray with hypertrophied myocytes
• B Fibrofatty replacement of the right ventricular myocardium ✓
• C Noncaseating granulomas with giant cells
• D Intermyocardial iron deposition

Explanation

Arrhythmogenic right ventricular cardiomyopathy results from mutations in desmosomal genes such as plakophilin-2, producing fibrofatty replacement of right ventricular muscle, epsilon waves on ECG, ventricular arrhythmias, and sudden death in young athletes. Myocyte disarray defines hypertrophic cardiomyopathy, granulomas indicate sarcoidosis, and iron deposition belongs to hemochromatosis. None of these alternatives explains the epsilon wave pattern.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.