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A middle-aged woman with a heavy heart
  1. Cedric Van de Bruaene1,
  2. Lara Crapé2,
  3. Veerle Surmont1
  1. 1 Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
  2. 2 Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
  1. Correspondence to Dr Cedric Van de Bruaene, Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, Ghent 9000, Belgium; Cedric.VandeBruaene{at}

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Clinical introduction

A 51-year-old woman was referred to our hospital with a 4-month history of progressive dyspnoea on exertion (New York Heart Association Functional Classification III), chest heaviness, dry cough, weight loss and tiredness. She worked as cleaning woman and had no relevant medical history, apart from an Epstein-Barr Virus (EBV) infection 2 months before symptom onset. She did not smoke and family history was negative.

On examination, blood pressure was 104/80 mm Hg and heart rate was regular at 145 bpm. On auscultation, heart sounds were distant, muffled and there was no murmur. Minimal, bilateral pitting oedema was observed. Laboratory findings were unremarkable. During hospitalisation, cardiac monitoring revealed paroxysmal new-onset atrial fibrillation.

Chest radiography from a previous hospital had revealed cardiomegaly and subsequent echocardiography had shown pericardial effusion with diastolic dysfunction, for which she had received …

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