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JAMA Cardiology Clinical Challenge
March 2018

A Woman in Her Late 50s With Palpitations and Light-headedness

Author Affiliations
  • 1Cardiology Department, Suez Canal University, Ismailia, Egypt
  • 2Department of Cardiovascular Science, University of Leicester, Leicester, England
  • 3Department of Cardiology, Glenfield Hospital, Leicester, England
  • 4Department of Cardiology, Kettering General Hospital NHS Foundation Trust, Kettering, England
JAMA Cardiol. 2018;3(3):262-263. doi:10.1001/jamacardio.2017.3402

A white woman in her late 50s presented with palpitations, breathlessness, chest pain, and episodes of light-headedness. Her risk profile included a family history of sudden cardiac death: her cousin died unexpectedly in his mid-40s while playing football. A physical examination showed no remarkable findings. Her systolic blood pressure was 125 mm Hg, diastolic blood pressure was 70 mm Hg, and resting heart rate was 52 beats/min. Portions of her electrocardiogram (Figure 1A) and 24-hour Holter monitoring trace (Figure 1B) are shown. Echocardiographic findings included mildly impaired systolic function (left ventricular ejection fraction, 45%-50%) but were otherwise normal. Coronary angiography was performed and revealed normal coronary arteries.

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