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Congenital heart disease
Image challenge
Dyspnoea on exertion in a 53-year-old woman
  1. Eftihia Sbarouni,
  2. Panagiota Georgiadou,
  3. Vassilis Voudris
  1. Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
  1. Correspondence to Dr Panagiota Georgiadou, Division of Interventional Cardiology, Onassis Cardiac Surgery Center, 356 Syngrou Avenue, Athens 176 74, Greece; georgiadou{at}ocsc.gr

https://doi.org/10.1136/heartjnl-2017-311256

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    Clinical introduction

    A 53-year-old woman with no previous medical history complained of easy fatigue over the last 6 months. She had a positive family history for coronary artery disease but no other risk factors. On physical examination, a 3/6 pansystolic murmur was heard over the apex, and the lung auscultation was unremarkable. Her ECG showed a left anterior fascicular block, with poor R wave progression in the anterior leads (see online supplementary image A). A subsequent echocardiogram revealed a slightly dilated for the patient’s body surface area (BSA) (1.73 m2) left ventricle (55/35 mm), with preserved systolic function and a moderate functional mitral regurgitation. The estimated pulmonary artery pressure was 45 mm Hg. During treadmill radionuclide scintigraphy, …

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    Footnotes

    • Contributors ES and PG contributed to the collection and interpretation of data. VV critically revised the final draft.

    • Competing interests None declared.

    • Patient consent Obtained.

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

    • Data sharing statement There are no additional unpublished data.