Abstract
A 53-year-old white man with prior hypertension and hyperlipidemia was sent to the hospital from his physician's office with chest pain and atrial fibrillation. His rapid heart rate was slowed with a diltiazem drip. Echocardiography demonstrated an ejection fraction of approximately 20%. Cardiac catheterization showed severe global left ventricular hypokinesis but no significant coronary narrowing. He had a “left dominant” circulation. An identical twin brother had also presented to another hospital 1 year earlier with atrial fibrillation and depressed cardiac function. The patient's twin had also undergone left-sided heart catheterization, which had revealed a depressed left ventricular ejection fraction, no coronary narrowing, and a “left dominant” circulation (Figure). Figure Invasive angiogram of monozygotic twins: (a) the index case and (b) his brother. There is no appreciable coronary artery disease in the left anterior descending artery (LAD), left circumflex artery (LCx), or obtuse marginals (OM). The twins are both noted ...
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