26 y/o male with dizziness and SOB

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?

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