A 33-year-old man presented with a 3-week history of breathlessness and cough. He disclosed that he was informed regarding a heart defect as a child in his home country but was unaware of its nature and was never followed up. Examination revealed a pansystolic murmur (loudest at the apex), a hyperdynamic, displaced apex, and pulmonary oedema. An ECG showed atrial fibrillation with a regular broad-complex ventricular rhythm. Following electrical cardioversion, the ECG revealed complete heart block, therefore explaining the regular atrial fibrillation. An urgent transthoracic echocardiography (TTE) confirmed the anatomy of congenitally corrected transposition of the great arteries (CCTGA) with torrential tricuspid regurgitation and impaired systemic right ventricle. Cardiac MRI identified a ventricular septal defect which was not visible on TTE. The patient showed a transient improvement following fluid offloading and ACE inhibition, with a more definitive improvement after cardiac resynchronisation therapy (CRT).
- heart failure
- pacing and electrophysiology
- migration and health
- radiology (diagnostics)
- congenital disorders
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Contributors NG: Conception, design, acquisition and interpretation of data, drafting, final approval and agrees to be accountable for all aspects of the work. AB: Acquisition, interpretation of data, critical revision, final approval and agrees to be accountable for all aspects of the work. MAS: Interpretation of data, critical revision, final approval and agrees to be accountable for all aspects of the work. MC: Conception, acquisition and interpretation of data, critical revision, final approval and agrees to be accountable for all aspects of the work.
Funding The research work disclosed in this publication is partially funded by the Endeavour Scholarship Scheme (Malta). Scholarships are part-financed by the European Union - European Social Fund (ESF) - Operational Programme II – Cohesion Policy 2014–2020: 'Investing in human capital to create more opportunities and promote the well-being of society'. Award Number: 734/2018/869.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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