Arrhythmogenic Right Ventricular Cardiomyopathy as a Cause of Palpitations and Syncope in an Otherwise Healthy Active Duty Female

Identifying the cause of palpitations and syncope in the healthy, active duty military population is important. Most often, the causes are benign, but more malignant etiologies should not be overlooked. In this case, we present a 22-year-old active duty female soldier who developed exercise intolerance, palpitations, and ultimately one episode of exercise-induced syncope. Outpatient evaluation with Holter monitor revealed sustained ventricular tachycardia while exercising. Electrocardiogram revealed findings concerning for arrhythmogenic right ventricular cardiomyopathy based on the 2010 Revised Task Force Criteria. Further investigation with cardiac magnetic resonance imaging helped confirm the diagnosis. Sotalol was used as an antiarrhythmic therapy and an automatic implantable cardioverter defibrillator was implanted to reduce the risk of sudden cardiac death. This case represents an uncommon cause of palpitations and syncope. Arrhythmogenic right ventricular cardiomyopathy should be on the differential diagnosis in the active duty population who present with exercise-induced syncope.