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Image challenge
A 72-year-old male with recurrent syncope
  1. Dhanuka Perera1,
  2. Rakesh Uppal2,
  3. John Hogan1
    1. 1Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
    2. 2Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
    1. Correspondence to Dr Dhanuka Perera, Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK; dhanuka.perera{at}nhs.net

    Abstract

    Clinical introduction A 72-year-old patient presented with recurrent syncope 1 year after a myocardial infarction. Two recent falls resulted in fractures to the femur. Serial troponins were negative and ECG demonstrated fixed inferior ST-segment elevation and pathological Q waves. A Holter monitor recorded non-sustained ventricular tachycardia. A subsequent echocardiogram was abnormal, and further investigation with a three-dimensional (3D) cardiac CT coronary angiogram was performed (figure 1).

    Figure 1
    Figure 1

    Cardiac CT coronary angiogram—three-dimensional reconstruction.

    Question What is the most likely diagnosis?

    1. Cardiac tumour

    2. Hypertrophic obstructive cardiomyopathy

    3. Ventricular aneurysm

    4. Ventricular diverticulum

    Question

    http://dx.doi.org/10.1136/heartjnl-2016-309670

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      Footnotes

      • Collaborators Mr Delfin Encarnacion, Echo Technician, Department of Cardiology, St Bartholomew's Hospital, London, UK.

      • Contributors I am a clinical fellow in Cardiology working with JH, RU and DE. We were involved in the care of a patient with a very large ventricular aneurysm. The images are rather spectacular and may be of educational value therefore would like to share it with the medical community.

      • Competing interests None declared.

      • Patient consent Obtained.

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