Dyspnoea, dizziness and dysrhythmia in a middle-aged patient

Clinical introduction A middle-aged patient with no prior comorbidities presented to the emergency department with a sudden onset of palpitations, dizziness and progressive dyspnoea. History was negative for any cardiac disorders in the past. On examination, the pulse rate was around 190 beats/min with a systolic blood pressure of 80 mm Hg. ECG at presentation was suggestive of ventricular tachycardia (VT) (figure 1A). Resuscitation with urgent cardioversion in view of haemodynamic instability with wide complex tachycardia was done. Following cardioversion to sinus rhythm, examination revealed a soft first heart sound with a prominent pansystolic murmur. Laboratory evaluation revealed electrolytes, haematological profile, renal and liver panel to be within normal limits. N-terminal pro Brain Natiuretic Peptide(NT-proBNP)(ECLIA, Roche) was elevated at 1360 pg/mL. The chest X-ray showed an enlarged left cardiac border with calcification. The two-dimensional (2D) transthoracic echocardiogram revealed left ventricular ejection fraction of 40%....
Source: Heart - Category: Cardiology Authors: Tags: Image challenges Source Type: research