Article Text

Download PDFPDF
77-year-old female with syncope
  1. Mahmoud A Abdelsalam,
  2. Jeffrey B Geske
  1. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Jeffrey B Geske, 200 First Street SW, Rochester, MN 55905, USA; geske.jeffrey{at}


Clinical introduction A 77-year-old female was referred for evaluation of an episode of syncope while eating breakfast. There was no history of fall, syncope, prodrome, dyspnoea, chest discomfort or palpitations. Medical history was notable for hyperlipidaemia and treated hypertension. Blood pressure was 140/90 mm Hg, pulse 85  beats per minute (BPM). No murmurs were present on cardiac examination. ECG revealed normal sinus rhythm with left ventricular (LV) hypertrophy (see online supplementary figure S1). Holter monitor demonstrated rare premature ventricular complexes (<1% of beats), without heart block or ventricular tachycardia. Transthoracic echocardiogram is shown in figure 1.

Question Which of the following is the explanation for the flow indicated by the yellow arrow?

  1. Aortic stenosis

  2. Coronary artery flow, indicative of coronary fistula

  3. Hypertrophic cardiomyopathy with apical pouch

  4. Hypertensive heart disease

  5. Mitral stenosis

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter Follow Jeffrey Geske at @jeffreygeske

  • Contributors All authors participated in authoring of the submitted manuscript. All authors have reviewed the manuscript and approved the submitted version.

  • Competing interests None declared.

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

Linked Articles