Silent broken heart (Can shortness of breath be the only presentation of myocardial infarction?).

A 55-year-old previously healthy man was referred to our cardiology outpatient department (by the respiratory team) due to shortness of breath that started 2-3 months prior. He suddenly became breathless after changing a car wheel with no other associated symptoms. Specifically, he denied ever having had chest pain. His breathlessness got gradually worse preventing him from performing simple everyday activities, such as climbing stairs, and a couple of weeks before presentation, the patient noticed ankle oedema. He was an ex-smoker and drank 3-4 units of alcohol daily. There was a family history of hypertension. He worked as a contract manager in the construction industry. After clinical examination, a transthoracic echocardiogram was performed and the patient was admitted for further investigations. Clinical examination and investigation confirmed missed myocardial infarction with a complication of ventricular aneurysm. The patient was referred to cardiothoracic surgeons for surgical correction of the defect. 2015 BMJ Publishing Group Ltd.