An unusual cause of shortness of breath and palpitations

A 33 year old woman with recurrent short lived episodes of breathlessness and palpitations for over two years was referred to the cardiology clinic as an outpatient.

She had attended the emergency department several times during the two years of her symptoms, and had undergone various investigations, including two computed tomography pulmonary angiograms for suspected pulmonary embolism (normal both times) and a 24 hour electrocardiogram, which showed sinus rhythm with isolated ventricular ectopics only. She had also experienced one episode of sudden onset slurred speech and right arm weakness which resolved rapidly. Computed tomography imaging of the brain had been normal.

Her symptoms were originally attributed to anxiety and she was prescribed antidepressant medication for anxiety and depression.

In the cardiology clinic, she appeared anxious but otherwise comfortable and well. On examination of the cardiovascular system, heart sounds were normal with no obvious murmur. After review in the cardiology clinic she had an echocardiogram (figs 1, 2).