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).
Question What is the most likely diagnosis?
Hypertrophic obstructive cardiomyopathy
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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.