Abstract：
Special Operations Servicemembers presenting with palpitations, pre-syncope, or exertional syncope during rigorous physical training are often experiencing a benign condition; however, life-threatening etiologies should be considered. We describe a 43-year-old Special Operator who presented to his medics during selection physical assessment testing with palpitations and lightheadedness, with a subsequent workup revealing arrhythmogenic right ventricular cardiomyopathy (ARVC). His initial electrocardiogram was unremarkable without characteristic ARVC changes. Outpatient evaluation with ambulatory cardiac monitoring recorded numerous episodes of non-sustained ventricular tachycardia. Transthoracic echocardiography demonstrated findings concerning for ARVC, with subsequent cardiac MRI confirming the diagnosis via the 2020 Padua criteria. Management includes activity modification, class III anti-arrhythmic medications, and possible placement of an implantable cardioverter defibrillator to prevent sudden cardiac death. This case demonstrates the importance of maintaining high clinical suspicion for rare diagnoses that present with exertional palpitations, such as arrhythmogenic right ventricular cardiomyopathy, in even our fittest Special Operators.
摘要：
特种作战服务人员表现出心悸，晕厥前,在严格的体育锻炼中或劳累性晕厥通常会出现良性状况；然而，应考虑危及生命的病因。我们描述了一位43岁的特殊操作员，他在选择身体评估测试过程中表现出心悸和头晕，随后的检查显示心律失常性右室心肌病（ARVC）。他的初始心电图无异常，无特征性ARVC变化。通过动态心脏监测进行的门诊评估记录了许多非持续性室性心动过速发作。经胸超声心动图显示关于ARVC的发现，随后的心脏MRI通过2020帕多瓦标准确认诊断。管理包括活动修改，III类抗心律失常药物，以及可能放置植入式心律转复除颤器以防止心源性猝死。此病例证明了对表现为劳累性心悸的罕见诊断保持高度临床怀疑的重要性。如致心律失常性右心室心肌病，即使是我们最合适的特殊运营商。
