Ventricular tachycardia: a presentation of Fabry disease cas
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Fabry disease is an inherited rare metabolic disease caused by mutation in the GLA gene, encoding lysosomal enzyme alpha-galactosidase A.

The disorder is a systemic disease that manifests as cerebrovascular and cardiac disease, chronic renal failure, skin lesion, peripheral neuropathy, and other abnormalities. Ventricular tachycardia as a Fabry disease presentation is very rare.

Published in the European Heart Journal Case Reports, the authors present a case of a 36-year-old man who self-presented to a general practitioner complaining of episodes of shortness of breath together with a 6-month history of malaise. The 12-lead electrocardiogram (ECG) prompted a decision to transfer him immediately to a percutaneous coronary intervention (PCI) capable hospital under the suspicion of acute coronary syndrome.

Whilst awaiting transport, he experienced acute onset of dyspnoea together with non-specific chest heaviness. A repeat ECG monitor strip showed ventricular tachycardia transforming to ventricular fibrillation. The patient was successfully defibrillated. Coronary angiography was performed upon arrival at the hospital and demonstrated unobstructed coronary arteries.

Transthoracic echocardiography revealed concentric left ventricular hypertrophy (LVH) and normal systolic function, with severe diastolic dysfunction. MRI confirmed the LVH, and did not demonstrate any late gadolinium enhancement.

Learning Points:-
- This case illustrates the pivotal role of critical clinical thinking in the diagnosis of rare but treatable hereditary cardiomyopathy.

- Male patients with the classic form of the disease have very low alpha-galactosidase A activity.

- In all male patients, diagnosis must be confirmed by enzyme assay in leucocytes and DNA sequence analysis.

- The activity of alpha-galactosidase A may be normal in female carriers.

- Diagnosis of Fabry disease in females can be only confirmed by molecular genetic testing.

- The uncommon cardiac presentation of Fabry disease promotes further research linking different phenotypes of Fabry disease with different pathogenic mutations.

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