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Broad complex tachycardia in a 46-year-old man
  1. Abbas Zaidi,
  2. Baskar Sekar,
  3. Zaheer Yousef
  1. Department of Cardiology, University Hospital of Wales, Cardiff, UK
  1. Correspondence to Dr Abbas Zaidi, Cardiovascular Research Centre, St. George's University of London, London SW17 0RE, UK; abbaszaidi77{at}

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Clinical introduction

A 46-year-old South Asian male with no comorbidity presented with palpitations and presyncope. There was no history of chest pain, and no family history of premature atherosclerosis, cardiomyopathy or sudden death. The presenting ECG is shown in figure 1A. Routine blood tests, including full blood count and inflammatory markers, were unremarkable. Admission troponin I was elevated at 470 ng/L (normal 0–34 ng/L), peaking at 1450 ng/L. Serum angiotensin-converting enzyme was marginally elevated at 63 U/L (normal 8–52 U/L). Echocardiography demonstrated normal biventricular dimensions, with moderate biventricular systolic impairment. Invasive angiography revealed unobstructed coronary arteries. Cardiac magnetic resonance (CMR) imaging demonstrated marked hypokinesia of the interventricular septum and right ventricular outflow tract free …

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  • Contributors All authors have contributed significantly to the conception, design, writing, and review of this manuscript.

  • 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 statement This submission is based on the clinical experience of a single patient. Involvement of other patients or the public was not appropriate.

  • Patient consent for publication Obtained.

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