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Epicardial fat thickness is independently related to the extent of subclinical thoracic aortic atherosclerosis. Increase in EFTh may be crucial marker for initial atherosclerosis.

A 29-year old male patient presented with a hemodynamically significant ventricular tachycardia. Despite a comprehensive examination, the correct diagnosis was unfortunately established after two years. We discuss why the correct diagnosis was initially overlooked in physical examination, electrocardiogram, echocardiography and cardiac magnetic resonance imaging, and which findings led the cardiologists to misdiagnose the patient. We have organized this report in a format that the information is presented to a consultant physician by a resident physician to simulate the way such information emerges in the real life as we have encountered. The consultant physician responds as new information is presented, expressing his reasoning with the reader.