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exertion from 5 days ago. ECG and monitoring showed intermittent VT with a heart rate of 170 bpm (Fig. 1). On the transthoracic echocardiography (TTE), a cystic mass was noted in the left ventricular cavity. The cystic mass was developing inside the left ventricle and mildly compressing the outflow tract. There was no subaortic gradient and regurgitation or stenosis for the mitral and aortic leaflets. Transesophageal echocardiography (TEE) confirmed TTE and hydatid cyst, and the localization was determined (Fig. 2A and B, Video 1-2). Serial cardiac enzymes were positive for myocardial damage. A diagnostic coronary angiography was performed, which revealed no significant atherosclerotic stenosis of the coronary arteries. Abdominal ultrasonography showed an extracardiac cyst in the liver. The CT showed cystic lesions in the left ventricular cavity protruding into the left ventricular outflow tract and in the liver (Fig. 3). Finally, he underwent cardiac surgery under general anesthesia, and the large hydatid cyst was evacuated. There was no evidence of residual cyst in the intraoperative TEE. Our patient, interestingly and originally, presented with exertion syncope and ventricular tachycardia, with positive cardiac enzymes for myocardial damage, which, in this particular context, was mimicking acute coronary syndrome. However, the exercise-induced syncope and ventricular tachycardia was probably explained by obstruction of the left ventricular outflow tract, such as in obstructive cardiomyopathies. We could not determine the subaortic gradient by continuous wave Doppler, but the reason couldn't be measured perpendicular to flow.

Ventricular tachycardia and syncope: A complication of an echinococcal cyst caused by left ventricular outflow tract obstruction