Adult with exertional dyspnoea and abnormal ECG

A man in his 60s with hypertension and tobacco use presented to the outpatient clinic with 3-month progressive exertional dyspnoea. ECG showed sinus rhythm with poor R-wave progression in the precordial leads. Transthoracic echocardiography (TTE) revealed normal left ventricular (LV) size and function. Coronary angiography showed no significant stenosis. However, left ventriculography found a narrow neck, thin-walled outpouching at the apex with synchronous contraction (figure 1A, B and video 1). Subsequently, MRI confirmed a small LV outpouching on the apex measuring 17×12 mm, which contained myocardium (figure 1C, D and video 2). On late gadolinium enhancement images, the entire LV myocardium was nulled without evidence of scar. During the period of follow-up, the size and location of his LV outpouching remained unchanged over time. Open in a separate window Figure 1 Ventriculogram (right anterior oblique projection) showing the contrast-filled outpouching at the apex during systole (A) and diastole (B). MRI (long axial plane of the left ventricular view) showing a small outpouching on the apex during systole (C) and diastole (D).