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 1
A). 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%. The 2D echocardiogram and cardiac CT images are shown below (figure 1B–D and online supplemental video 1).

N -terminal pro Brain Natiuretic Peptide(NT-proBNP)(ECLIA, Roche) was elevated at 1360 pg/mL. The chest X-ray showed an enlarged …