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Image challenge
Man with an ejection systolic murmur
  1. Dinkar Bhasin,
  2. Rahul Kumar,
  3. Preeti Gupta
  1. Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
  1. Correspondence to Dr Preeti Gupta, Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India; drpreetisjh{at}gmail.com

http://dx.doi.org/10.1136/heartjnl-2021-319841

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    Clinical introduction

    A man in his 60s was referred to our clinic as a part of preoperative evaluation for non-cardiac surgery. The patient did not have any cardiovascular symptoms and had never been evaluated previously. Examination revealed a low volume pulse and an ejection systolic murmur best heard in the left parasternal region. An early diastolic murmur was also heard. The ejection systolic murmur decreased in intensity with Valsalva manoeuvre.

    Question

    The transthoracic echocardiogram is shown in figure 1 (online supplemental video). What is the diagnosis?

    Supplementary video

    [heartjnl-2021-319841supp001.mp4]
    Figure 1

    Transthoracic echocardiography (A) Apical five-chamber view. (B) Colour Doppler imaging.

    1. Hypertrophic cardiomyopathy (HCM)

    2. Valvular aortic stenosis

    3. Supravalvular aortic stenosis

    4. Subaortic membrane

    Answer: D

    The echocardiogram shows a discrete subaortic membrane causing subvalvular aortic stenosis. The colour Doppler across aortic …

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    Footnotes

    • DB and RK are joint first authors.

    • DB and RK contributed equally.

    • Contributors All authors contributed to design, data acquisition, draft preparation and final review of the 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 Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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