Signature ECG part 5: Exercise induced syncope

14-year-old boy presented with aborted sudden cardiac arrest during exertion. His brother died suddenly at 16 years of age during an emotional situation. On stress testing, patient developed classical bidirectional PVCs typical of CPVT (Catecholaminergic polymorphic ventricular tachycardia). The genetic testing showed pathogenic heterozygous variant in CASQ₂ gene. Patient was started on propranolol and flecainide and advised to avoid strenuous physical activity.