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Dyspnoea, dizziness and dysrhythmia in a middle-aged patient
  1. Vijay Soorampally1,2,
  2. Sriram Veeraraghavan3,
  3. Bharath Raj Kidambi4
  1. 1 Cardiology, Trilife Hospital, Bangalore, Karnataka, India
  2. 2 All India Institute of Medical Sciences, New Delhi, Delhi, India
  3. 3 Cardiology, SRM Medical College Hospital and Research Centre, Kancheepuram, Tamil Nadu, India
  4. 4 Cardiology, All India Institute of Medical Sciences, Al Dhannah, Abu Dhabi, UAE
  1. Correspondence to Dr Sriram Veeraraghavan, Cardiology, SRM Medical College Hospital and Research Centre, Kancheepuram, Tamil Nadu 603203, India; sriramv{at}srmist.edu.in

https://doi.org/10.1136/heartjnl-2023-323787

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    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).

    Supplementary video

    [heartjnl-2023-323787supp002.mp4]

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

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    Footnotes

    • Twitter @drbk67332258

    • Contributors SV—study conception and design, data collection, analysis and interpretation of results. VS—supervision and manuscript revision. BRK—draft manuscript preparation. All authors have reviewed the results and approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.