case_images: PMC8565682_01
case_images: ECG aspect: Supraventricular tachycardia 150/min, inverted P waves in V1, suggestive for right atrial origin, positive P waves in inferior leads suggestive for a superior site of origin- possible right atrial tachycardia
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case_images: acc-07-02-28-g001
case_images: Transthoracic echo: Enlarged heart with severe impairment of LVEF, moderate mitral regurgitation, small pericardial effusion
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case_images: PMC8565682_01_acc-07-02-28-g002.jpg
case_images: acc-07-02-28-g002
case_images: Transthoracic echocardiography showed a globally enlarged heart, with severe impairment of left ventricular ejection fraction and diffuse hypokinesia (ejection fraction of 20% by the Simpson biplane method) (Figure 2).
case_images: ECG aspect: Sinus rhythm 80 bpm, biphasic P waves with prolonged duration (120 ms), negative T waves in V5, V6, DII and flattened T waves in DII, aVF
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case_images: After reaching a more convenient heart rate, the ECG showed sinus rhythm, biphasic P waves with prolonged duration (120ms), which is diagnosis for an advanced interatrial block with left atrial retrograde activation (Bayes syndrome) (Figure 3).
case_images: Coronary CT angiogram: normal epicardial coronary arteries
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case_images: The coronary computed tomography (CT) angiogram excluded an ischemic heart disease (Figure 4).
case_images: Cardiac MRI: the presence of diffuse fibrosis of the interstitial space and an important increase of the extracellular volume of the LV (T2Map 42 ms, T1 pre 1280 ms, T1 post 482 ms, ECV 33%)
case_images: acc-07-02-28-g005.jpg
case_images: PMC8565682_01_acc-07-02-28-g005.jpg
case_images: acc-07-02-28-g005
case_images: T1post: 482ms, ECV: 33%). The right ventricle was slightly dilated with normal systolic function (EDV 203 ml, ESV 102 ml, EF 50%), but with impairment in both longitudinal and circumferential strain (-11 % and -6%). The left atrium was moderately dilated (56/47/51 mm, area 28 cm2) (Figure 5).