4th May 2025

A 19-year-old man has been referred by his GP following an exertional collapse.

A 19-year-old man has been referred by his GP following an exertional collapse. The patient is a university student and collapsed whilst playing football. The collapse was preceded by palpitations, and he had no warning prior to losing consciousness. There were no convulsions reported, and he was not postictal afterwards.

His observations are HR 60, BP 130/70mmHg, RR 22, Temp 36.9. His GP has also kindly organised an ECHO and Holter monitor.

ECHO report: Left ventricular hypertrophy with thickness of 17mm with septal hypertrophy. LVOT gradient of 35mmHg. LVEF 60%. 

Holter report: 3 episodes of non-sustained ventricular tachycardia lasting 7 seconds at a rate of 160 bpm.

Whilst you are reviewing him and discussing his echo results, he collapses. His cardiac monitor shows a sustained broad-QRS tachycardia. 

What is the most appropriate initial management?

Select the SINGLE most appropriate option from the list below. Select ONE option only.