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02-08-2018 | Rhythm Puzzle – Question | Uitgave 9/2018 Open Access

Netherlands Heart Journal 9/2018

A peek behind the curtain

Netherlands Heart Journal > Uitgave 9/2018
M. Kamali-Sadeghian, P. T. G Bot, R. Tukkie, H. J. Wellens, D. J. van Doorn


A 67-year-old male was referred to the outpatient clinic of our hospital with crescendo angina pectoris since one month. He had been diagnosed with atrial fibrillation in a general practice three days earlier and treatment with metoprolol and apixaban was initiated. He was an otherwise healthy and active cyclist who smoked a cigar on occasion. There were no other risk factors for coronary artery disease. An echocardiogram performed five years ago because of persistent bradycardia, was normal.
Physical and laboratory examination on admission did not reveal any abnormalities. His initial troponin I level was 11 ng/l, with repeat troponin I concentration found at 14 ng/l (normal range 0–10 ng/l). The resting electrocardiogram at presentation is shown in Figs.  1 and  2.
What is your diagnosis based on the electrocardiographic findings?
What would be your next step or treatment?


You will find the answer elsewhere in this issue.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

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Rhythm Puzzle – Answer

A peek behind the curtain