A middle-aged patient with no prior comorbidities presented to the emergency department with a sudden onset of palpitations, dizziness and progressive dyspnoea. History was negative for any cardiac disorders in the past. On examination, the pulse rate was around 190 beats/min with a systolic blood pressure of 80 mm Hg. ECG at presentation was suggestive of ventricular tachycardia (VT) (figure 1 A). Resuscitation with urgent cardioversion in view of haemodynamic instability with wide complex tachycardia was done. Following cardioversion to sinus rhythm, examination revealed a soft first heart sound with a prominent pansystolic murmur. Laboratory evaluation revealed electrolytes, haematological profile, renal and liver panel to be within normal limits. N-terminal pro Brain Natiuretic Peptide(NT-proBNP)(ECLIA, Roche) was elevated at 1360 pg/mL. The chest X-ray showed an enlarged left cardiac border with calcification. The two-dimensional (2D) transthoracic echocardiogram revealed left ventricular ejection fraction of 40%. The 2D echocardiogram and cardiac CT images are shown below (figure 1B–D and online supplemental video 1). ### Supplementary video [heartjnl-2023-323787supp002.mp4] N -terminal pro Brain Natiuretic Peptide(NT-proBNP)(ECLIA, Roche) was elevated at 1360 pg/mL. The chest X-ray showed an enlarged …

中文翻译：

---

中年患者呼吸困难、头晕、心律失常

一名既往没有合并症的中年患者因突然出现心悸、头晕和进行性呼吸困难而被送往急诊科。过去没有任何心脏病史。检查时，脉搏约为 190 次/分钟，收缩压为 80 毫米汞柱。就诊时心电图提示室性心动过速 (VT)（图 1 A）。鉴于血流动力学不稳定并伴有广泛的复杂性心动过速，进行了紧急心脏复律复苏。复律至窦性心律后，检查发现第一心音柔和，伴有明显的全收缩期杂音。实验室评估显示电解质、血液学特征、肾脏和肝脏指标均在正常范围内。 N 端脑钠肽前体 (NT-proBNP)（ECLIA，罗氏）升高至 1360 pg/mL。胸部X光检查显示左心边界扩大并伴有钙化。二维 (2D) 经胸超声心动图显示左心室射血分数为 40%。二维超声心动图和心脏 CT 图像如下所示（图 1B-D 和在线补充视频 1）。 ### 补充视频 [heartjnl-2023-323787supp002.mp4] N 端脑钠肽前体 (NT-proBNP)（ECLIA，罗氏）升高至 1360 pg/mL。胸部X光检查显示肿块增大……