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Cold feet, warm heart
  1. Rong Bing1,2,
  2. Mardi Hamra1,
  3. David E Newby1,2
  1. 1 Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2 Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Rong Bing, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh EH164SA, UK;{at}

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Clinical introduction

A 38-year-old man presented with 4 weeks of exertional dyspnoea and abdominal bloating, culminating in an acute episode of paroxysmal nocturnal dyspnoea. He was known to have a cardiomyopathy based on history and echocardiography but had been lost to follow-up before further investigations were completed. There was no chest pain, infective prodrome or recent travel. He smoked tobacco occasionally and drank approximately 50 units of alcohol per week. On examination, blood pressure was 110/80 and heart rate was 90. The jugular venous pressure was elevated. An S3 was heard but lungs were clear to auscultation. The abdomen was soft and mildly tender. Inflammatory markers and renal function were normal and high-sensitivity troponin I was 14 ng/L. Soon after …

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  • Contributors RB prepared the first draft. RB, MH and DEN reviewed and edited the final manuscript. All authors are responsible for the overall content.

  • Funding This work was supported by the British Heart Foundation (CH/09/002, RE/13/3/30183, RE/18/5/34216, PG/19/40/34422 and RG/16/10/32375 to DEN) and the Wellcome Trust (WT103782AIA to DEN).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.