26 year old male patient present to the ED complaining of dizziness, fatigue, and shortness of breath. The patient reports that his symptoms started 5 days ago, with headache and myalgia which he attributed to “a viral infection” but his symptoms didn’t improve prompting him to come to the ED. On reviewing the patient’s chart, you noticed that he had two previous ED visits with vague symptoms of chest pain and was discharged on omeprazole after a negative ischemic workup. On further history taking, the patient reports dizziness and palpitations every now and then. He also mentions that his uncle died suddenly and the cause of death was attributed to a “heart related condition”. Physical exam was remarkable for a fourth heart sound that is heard best at the apex and a 3/6 systolic murmur heard best at the left sternal border.
Laboratory work up showed:
Complete Blood Count:
WBC 11.0
Hgb 13.7
HCT 41.1
Platelet count 230
Serum Chemistries All within normal limits
Respiratory pathogen screen Positive Influenza B
The patient was admitted to the hospital and placed on telemetry. IV fluids and Oseltamivir “Tamiflu” were initiated. On the next day, you review telemetry and you notice 2 events of Ventricular tachycardia lasting 14 and 17 seconds respectively.
Cardiac Echo was done which shows:
-EF 55-60%
-Left ventricular hypertrophy – Thickness 32 mm
-Predicted Right Ventricular Systolic Pressure – 16 mmHg
-No pericardial effusion
Which of the following is the best step in the management of this patient?
Start Metoprolol
Reassurance and continue current therapy
Start Amiodarone
Evaluate for ICD placement
Start Amlodipine