A previously well 64-year-old man presented with 2 episodes of non-vertiginous giddiness during exercise. The patient had no history of drug use, prior history of syncope or family history of sudden cardiac death. Systolic blood pressure was 55 mmHg on presentation at the emergency department, with the presenting electrocardiography (ECG) shown (Fig. 1). Synchronised cardioversion was successfully performed and the postcardioversion ECG is as below (Fig. 1). The patient underwent a coronary angiogram which showed minor coronary artery disease, followed by transthoracic echocardiography and cardiac magnetic resonance imaging (MRI) (Figs. 2 and 3).
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