Coronary angiogram that was done 3 months back revealed normal coronaries. On 1st November patient had giddiness, loss of appetite and palpitations. Patient was taken to Shanthi Hospital, Kovai where ECG showed VT - DC verted and medically managed and then referred to the GKNM Hospital,Kovai . There she was admitted and treated for acute pulmonary edema, electrolyte disturbances, cardio genic shock and dialysis done and was discharged on 7th November. Patient was discussed as MVR / transplant / but the patient`s attender`s sought consult here in our OPD on 8th November and today they brought the patient to our ER for further evaluation and management.