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 …