An Unusual Echocardiogram

摘要

A 31-year-old female with no significant past medical history presented to the emergency room after 3 recent episodes of sudden onset of palpitations, shortness of breath, and a brief loss of consciousness. She denied chest pain, and there was no correlation with physical activity. Her pulse was irregularly irregular and there was no murmur by auscultation. She was afebrile, her blood pressure was 132/66 mmHg, andher electrocardiogram showed atrial fibrillation (AF) with a ventricular rate of 120 beats/min and no ischemic changes. She was admitted to the hospital for telemetry. All laboratory studies, including cardiac enzymes and thyroid hormone, were normal. A chest x-ray showed an abnormal cardiac silhouette with left-sided prominence. She was started on metoprolol and a diltiazem infusion with minimal response. She was also started on enoxaparin and later coumadin and was scheduled for cardioversion.