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Image challenge
Unusual cause of syncope
  1. Keying Bi1,
  2. Ke Wan2,
  3. Yucheng Chen1
  1. 1 Cardiology Division, West China Hospital of Sichuan University, Chengdu, Sichuan, China
  2. 2 Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China
  1. Correspondence to Dr Yucheng Chen, Cardiology Division, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China; chenyucheng2003{at}126.com

https://doi.org/10.1136/heartjnl-2023-323279

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    Clinical introduction

    A man in his 50s was admitted for recurrent syncope over 4 months. ECG demonstrated sinus rhythm, peripheral low voltage and T wave inversions in V3–V6 (figure 1A). Holter ambulatory monitoring showed normal sinus rhythm with atrial and ventricular premature beats. Electroencephalogram was normal. N-terminal pro-brain natriuretic peptide was elevated at 4631 ng/L, and troponin-T was elevated at 105 ng/L. Coronary angiography showed no obstructive disease. Transthoracic echocardiogram displayed increased wall thickness, dilated atria and decreased ejection fraction (48%) (figure 1B). Cardiac MRI was performed (figure 1C,D).

    Figure 1

    (A) ECG; (B) apical four-chamber transthoracic echocardiogram; (C) cardiac MRI, late gadolinium enhancement …

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    Footnotes

    • KB and KW are joint first authors.

    • Contributors YC initiated the study, defined its design and reviewed the manuscript. KB and KW were involved in the process of diagnosis, treatment and follow-up of the patient. KB acquired the image and clinical data, read the images and drafted the manuscript. KW revised the language of the manuscript. All authors read and approved the final manuscript.

    • Funding The National Natural Science Foundation of China (grant number 82000353) and Post Doctor Research Project, West China Hospital, Sichuan University (grant number 20HXBH143).

    • Competing interests None declared.

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