A 63-year-old woman presents with palpitations

摘要

A 63-year-old woman with a history of dwarfism presented with recurrent palpitations. She denied chest pain, dyspnoea or syncope. Her cardiac exam was notable for tachycardia at 188 bpm, hypotension (77/38) and no overt signs of heart failure. Cardiac markers were negative and her brain natriuretic peptide level was elevated at 687 pg/mL. An EKG revealed a left atrial tachycardia. She converted back to sinus rhythm after intravenous amiodarone. A chest X-ray demonstrated an enlarged cardiomediastinal silhouette. An initial transthoracic echocardiogram showed asymmetric septal hypertrophy, no LV outflow tract obstruction, normal LV systolic function, prolapse of the anterior and posterior mitral valve leaflets, and a finding marked by a question mark (figure 1). This finding was confirmed with a CT angiogram (figure 2). She was discharged home on oral amiodarone after the patient and her family refused catheter ablation and cardiac surgery.