Case History :
A 60-year-old man comes to the clinic complaining of shortness of breath, chest pain, dizziness and sensation of feeling his heart beating really fast for the past one hour. He has had previous such episodes for as long as he could remember. He describes the pain as tightness and also adds that his chest pain is more when he is laying flat on the bed or when he is asleep. None in the family present with such symptoms except him and his personal habits are good. He has no past history of any chronic illness like diabetes or hypertension.
On examination the patient was apparently well. His BP was 155/60 mmHg. Pulse 70/minute and regular. JVP was normal it is found that there is no edema; no pallor and all his vitals are within normal limits. Systemic examination is normal except that on auscultation over the heart, a "tumour plop" is heard when the patient changes his position while lying down.