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Image challenge
Echocardiography of a young man with dyspnoea
  1. Ana Luiza Horta de Sá Carneiro,
  2. Renato Braulio,
  3. Maria Carmo Pereira Nunes
  1. Hospital das Clínicas, School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
  1. Correspondence to Dr Maria Carmo Pereira Nunes, Department of Internal Medicine, School of Medicine of the Federal University of Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, 30130 100 – Belo Horizonte, MG, Brazil; mcarmo{at}waymail.com.br

https://doi.org/10.1136/heartjnl-2014-307349

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    Clinical introduction

    A 19-year-old man presented with a 4-month history of progressively worsening shortness of breath on exertion associated with atypical chest pain. He had a history of heart murmur detected during childhood, but otherwise, he was well. He denied having a previous diagnosis of rheumatic fever. Physical examination revealed a water hammer pulse and a holodiastolic and systolic murmur in the aortic area. A transthoracic echocardiogram showed normal LV systolic function and a pressure gradient within the left ventricular outflow tract (LVOT) (figure 1).

    Figure 1

    Transthoracic echocardiogram apical long-axis view (A); colour flow imaging at the left ventricular outflow tract level (B).

    Question

    Which of the following is the most likely diagnosis? …

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    Footnotes

    • Contributors All authors have read and approved the case. Each author has contributed significantly to the work. ALHdSC was responsible for conception, design, review of literature and writing the case, RB was responsible for the cardiac surgery and MCPN made important contributions towards interpretation of the images.

    • Competing interests None.

    • Patient consent Obtained.

    • Ethics approval The study was approved by the institutional clinical research, and the subject gave informed consent.

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

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