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Man in his 50s with chest pain and dyspnoea
  1. Yuki Obayashi,
  2. Chisato Izumi,
  3. Yoshihisa Nakagawa
  1. Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
  1. Correspondence to Dr Chisato Izumi, Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; izumi-ch{at}


Clinical introduction A man in his 50s with sudden-onset chest pain and dyspnoea was transferred to the emergency room. He had a history of aortic valve replacement due to aortic regurgitation with a mechanical valve 6 years previously. Heart rate was 90 bpm, and blood pressure was too low to measure. In the emergency room, he presented with severe dyspnoea and a chest X-ray showed severe lung congestion (figure 1A). ECG showed complete left bundle branch block. His respiratory status rapidly worsened, and he went into cardiopulmonary arrest. After cardiopulmonary resuscitation, transthoracic echocardiography was performed (figure 1B, online supplementary video 1).

Supplementary file 1

Figure 1

(A) Chest X-ray. (B) Colour Doppler image from apical five-chamber view.

Question What is the most likely cause of the patient’s cardiopulmonary arrest?

  1. Myocardial infarction in left main trunk

  2. Aortic dissection

  3. Prosthetic valve thrombosis

  4. Prosthetic valve embolisation

  5. Pulmonary embolism

  • endocarditis
  • prosthetic heart valves

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  • Contributors YO designed the study and wrote the initial draft of the manuscript. CI and YN critically reviewed the manuscript.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval The Institutional Ethical Committee of Tenri Hospital.

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