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Image challenge
Atypical chest pains in a middle-aged man
  1. Yudong Peng,
  2. Wei Xu,
  3. Mimamsa Khatiwada
  1. Department of Ultrasound, Jingzhou No. 1 People's Hospital and First Affiliated Hospital of Yangtze University, Jingzhou, China
  1. Correspondence to Yudong Peng, Ultrasound, Jingzhou No1 People's Hospital and First Affiliated Hospital of Yangtze University, Jingzhou, China; dong12095dong{at}sohu.com

https://doi.org/10.1136/heartjnl-2020-317617

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    Clinical introduction

    A middle-aged man presented with a 6-day history of chest pains and polypnea. On admission, he was normotensive (104/70 mm Hg) and had a normal heart rate (95 bpm). The ECG showed sinus rhythm with Q waves in leads V1–V5. Blood analysis revealed evidently elevated troponin I. Transthoracic echocardiogram revealed the anterior wall of left ventricle and the interventricular septum were akinetic with an ejection fraction of about 43%. Colour Doppler imaging and enhanced echocardiogram were performed in the meantime (figure 1). The coronary angiogram revealed a complete occlusion of left anterior descending artery in the initiative tract.

    Figure 1

    (A) Apical five-chamber systolic freeze frame. (B) Parasternal short-axis systolic freeze frame. (C) Doppler imaging in apical five-chamber diastolic freeze frame. (D) Enhanced imaging in apical …

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    Footnotes

    • Contributors All authors contributed to acquisition of clinical and imaging data, ideation and draft of the article.

    • 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.

    • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

    • Patient consent for publication Obtained.

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