Unusual echocardiogram in a 38-year-old man with loss of consciousness and systolic murmur

A 38-year-old man presented with two episodes of transient loss of consciousness accompanied by intermittent palpitations and some episodes of dizziness over the last several months. Loss of consciousness was associated with the loss of postural tone followed once by a fall with a head injury. He had no prior cardiac history but was diagnosed with lymphoblastic lymphoma at the age of 7 years. He had been treated with irradiation to the left supraclavicular region and subsequent chemotherapy. Physical examination revealed 3/6 crescendo-decrescendo systolic murmur best heard at the second intercostal space in the right upper sternal border and radiating to the carotid arteries. There was also other 2/6 holosystolic murmur loudest over the apex with radiation to the left axilla. An ECG demonstrated normal sinus rhythm …