PT  - JOURNAL ARTICLE
AU  - Yuki Obayashi
AU  - Chisato Izumi
AU  - Yoshihisa Nakagawa
TI  - Man in his 50s with chest pain and dyspnoea
AID  - 10.1136/heartjnl-2017-312477
DP  - 2018 May 01
TA  - Heart
PG  - 868--868
VI  - 104
IP  - 10
4099  - http://heart.bmj.com/content/104/10/868.short
4100  - http://heart.bmj.com/content/104/10/868.full
SO  - Heart2018 May 01; 104
AB  - Clinical introduction A man in his 50s with sudden-onset chest pain and dyspnoea was transferred to the emergency room. He had a history of aortic valve replacement due to aortic regurgitation with a mechanical valve 6 years previously. Heart rate was 90 bpm, and blood pressure was too low to measure. In the emergency room, he presented with severe dyspnoea and a chest X-ray showed severe lung congestion (figure 1A). ECG showed complete left bundle branch block. His respiratory status rapidly worsened, and he went into cardiopulmonary arrest. After cardiopulmonary resuscitation, transthoracic echocardiography was performed (figure 1B, online supplementary video 1).Supplementary file 1 [SP1.mov] Figure 1 (A) Chest X-ray. (B) Colour Doppler image from apical five-chamber view.Question What is the most likely cause of the patient’s cardiopulmonary arrest?Myocardial infarction in left main trunkAortic dissectionProsthetic valve thrombosisProsthetic valve embolisationPulmonary embolism