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Image challenge
Case of presyncope with mitral regurgitation
  1. Sudipta Mondal,
  2. Swasthi S Kumar,
  3. Vishnu Kesavan
  1. Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, KL, India
  1. Correspondence to Dr Sudipta Mondal, Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, KL, India; sudiptamondalnrs{at}gmail.com

https://doi.org/10.1136/heartjnl-2023-323447

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    Clinical introduction

    A woman in her 70s presented with mild dyspnoea on exertion with occasional presyncope. Her pulse was 38 beats/min and regular. There was no cardiomegaly. On auscultation, she was found to have a probable late diastolic or presystolic murmur of variable duration. She also had a pan-systolic grade 2/6 murmur at the apex. Continuous wave Doppler imaging at the mitral valve has been provided in figure 1.

    Figure 1

    Continuous wave Doppler imaging at the mitral valve.

    Question

    What is the likely aetiology and the cause of late diastolic murmur?

    1. Complete heart block (CHB) with diastolic mitral regurgitation (MR)

    2. Rheumatic mitral stenosis with MR

    3. CHB with systolic and diastolic MR

    4. A 2:1 atrioventricular …

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    Footnotes

    • Twitter @Sudiptanrs, @vishnukesavan2k7

    • Collaborators Not applicable.

    • Contributors SM led the conceptualisation, formal analysis, writing of the original draft, writing of the review and editing; SSK and VK contributed equally to writing of the review and editing.

    • 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.

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