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A man in his 50s presented to the emergency department with recurrent syncope. His medical history was notable for diabetes mellitus and hypertension. ECG showed a complete heart block with a ventricular escape rate of 30 beats per minute. Transvenous temporary pacemaker was inserted. Transthoracic echocardiography (TTE) showed severe left ventricular dilation and systolic dysfunction, ejection fraction of 30%. A modified apical four-chamber view showed an unexpected structure (figure 1, online supplemental video).
What is the structure shown in figure 1?
Calcified coronary artery
Retroaortic anomalous coronary artery
Aortic valve calcification
C. Retroaortic anomalous coronary artery …
Twitter @akapil15, @Nirmal Ghati @GhatiNirmal
Contributors AT and AK conceptualised the manuscript and wrote the draft. NG and AT were involved in revision of the manuscript and patient care. All the authors discussed the results and commented on the manuscript at all stages.
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.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.