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Image challenge
Man with recent inferior wall myocardial infarction
  1. Dinkar Bhasin1,
  2. Rahul Kumar2,
  3. Anunay Gupta2
  1. 1 Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
  2. 2 Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
  1. Correspondence to Dr Anunay Gupta, Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India; dranunaygupta{at}gmail.com

https://doi.org/10.1136/heartjnl-2021-320648

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    Clinical introduction

    A man in his 50s presented with progressive worsening of dyspnoea after a recent inferior wall myocardial infarction. His vitals were stable and examination revealed a pansystolic murmur at the apex. The patient had undergone a coronary angiography prior to referral which showed complete obstruction of the distal left circumflex artery.

    Question

    The transthoracic echocardiogram is shown in figure 1 and video 1.

    Figure 1

    Transthoracic echocardiography. (A) Parasternal long axis view, (B) parasternal short axis view.

    Video 1

    What is the diagnosis?

    1. Left ventricular pseudoaneurysm

    2. True aneurysm

    3. Ventricular septal rupture

    4. Free wall rupture

    Answer: A

    The echocardiogram shows a small defect in the inferior wall of the left ventricle (LV) communicating with a sac-like structure. Colour Doppler across the defect shows …

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    Footnotes

    • Twitter @anunay_cardio

    • Contributors All authors contributed to design, draft preparation and 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.