PMC5362718_01
(a) Initial electrocardiogram (ECG) of the patient at the emergency department (ED). (b) Follow-up ECG at the ward 24 hours later.
CRIC2017-4563203.001.jpg
PMC5362718_01_CRIC2017-4563203.001.jpg
fig1
An initial ECG showed a premature atrial contraction and insignificant ST-T changes (Figure 1(a)). Due to the exacerbated symptoms at the ward, a second ECG was performed, which showed new diffused T wave inversion over leads II, III, aVF, and V4-6 (Figure 1(b)).
(a) Left ventricle apical hypokinesis during the systolic phase. (b) Mild to moderate mitral valve regurgitation was noted.
CRIC2017-4563203.002.jpg
PMC5362718_01_CRIC2017-4563203.002.jpg
fig2
A transthoracic echocardiogram revealed mild to moderate mitral regurgitation and anterior-apical wall hypokinesis with ejection fraction of 41% (Figures 2(a) and 2(b)).
(a), (b) Patent left and right coronary arteries and (c) typical apical ballooning of the left ventricle at the systolic phase.
CRIC2017-4563203.003.jpg
PMC5362718_01_CRIC2017-4563203.003.jpg
fig3
TTC (Figure 3(c)). The symptoms improved after several days' treatment with diuretics (furosemide, 20 mg twice per day) and propranolol (10 mg, twice per day).
A circumscribed mass with near total obstruction of the sigmoid colon.
CRIC2017-4563203.004.jpg
PMC5362718_01_CRIC2017-4563203.004.jpg
fig4
At OPD, a colonoscopy was further arranged due to intermittent lower abdominal pain during defecation, which accidentally revealed a circumscribed mass with near total obstruction of the sigmoid colon about 20 cm from the anal verge (Figure 4).