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An 89-year-old man presents with worsening heart failure
  1. Gordon A G McKenzie1,2,
  2. Bradley Porter1,3,
  3. Raffi Kaprielian1,3
  1. 1Department of Cardiology, West Middlesex University Hospital, Isleworth, UK
  2. 2Academic Surgical Unit, St. Mary's Hospital, London, UK
  3. 3Department of Cardiology, Hammersmith Hospital, London, UK
  1. Correspondence to Dr Gordon A G McKenzie, Academic Surgical Unit, St. Mary's Hospital, Praed Street, London W2 1NY, UK; gordon.mckenzie{at}doctors.org.uk

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Clinical introduction

An 89-year-old man with a history of heart failure with preserved ejection fraction presented with worsening dyspnoea, reduced exercise capacity and peripheral oedema. His medical history was significant for hypertension, paroxysmal atrial fibrillation (AF), chronic obstructive pulmonary disease and Lyme disease (1983). Admission cardiovascular medications included aspirin 75 mg once a day, perindopril 6 mg once a day, furosemide 40 mg two times a day, flecainide 100 mg two times a day and simvastatin 40 mg one a night. On examination, he was normothermic and clinically in heart failure with raised jugular venous pressure, bibasal pulmonary crepitations and oedema up to …

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