PT  - JOURNAL ARTICLE
AU  - Mahmoud A Abdelsalam
AU  - Jeffrey B Geske
TI  - 77-year-old female with syncope
AID  - 10.1136/heartjnl-2016-310250
DP  - 2017 Feb 15
TA  - Heart
PG  - 315--315
VI  - 103
IP  - 4
4099  - http://heart.bmj.com/content/103/4/315.short
4100  - http://heart.bmj.com/content/103/4/315.full
SO  - Heart2017 Feb 15; 103
AB  - Clinical introduction A 77-year-old female was referred for evaluation of an episode of syncope while eating breakfast. There was no history of fall, syncope, prodrome, dyspnoea, chest discomfort or palpitations. Medical history was notable for hyperlipidaemia and treated hypertension. Blood pressure was 140/90 mm Hg, pulse 85  beats per minute (BPM). No murmurs were present on cardiac examination. ECG revealed normal sinus rhythm with left ventricular (LV) hypertrophy (see online supplementary figure S1). Holter monitor demonstrated rare premature ventricular complexes (<1% of beats), without heart block or ventricular tachycardia. Transthoracic echocardiogram is shown in figure 1.Question Which of the following is the explanation for the flow indicated by the yellow arrow? Aortic stenosisCoronary artery flow, indicative of coronary fistulaHypertrophic cardiomyopathy with apical pouchHypertensive heart diseaseMitral stenosis