{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T20:42:08Z","timestamp":1762980128516,"version":"3.40.4"},"reference-count":18,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2014,12,6]]},"abstract":"<jats:p>A 39-year-old hypothyroid woman on thyroxine replacement therapy presented with an unresolving episode of palpitations (narrow-complex tachycardia). Clinical examination, after reversion to normal sinus rhythm revealed a precordial continuous murmur. Initial transthoracic echocardiogram showed an unruptured aneurysm of left sinus of Valsalva (LSOV), however, because a continuous murmur could not be explained by this condition, a repeat colour Doppler study was made, revealing a communicating tract from the left main coronary artery (LMCA) and terminating in the right atrium (RA). A transesophageal echocardiogram revealed an aneurysmal LMCA and LSOV, with similar colour Doppler findings. A further CT scan and coronary angiogram confirmed a coronary cameral fistula opening into RA. In conclusion, the relevance of a diligent clinical examination and imaging after conversion to normal sinus rhythm in picking up such anomalies cannot be over-emphasised, as previous routine echocardiograms on the same patient had been reported as normal.<\/jats:p>","DOI":"10.1136\/bcr-2014-207197","type":"journal-article","created":{"date-parts":[[2015,1,7]],"date-time":"2015-01-07T18:49:13Z","timestamp":1420656553000},"page":"bcr2014207197","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["The dilemma of evaluating a continuous murmur in a patient of aneurysm of sinus of Valsalva and coronary cameral fistula presenting with supraventricular 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