Clinical introduction

A man in his 60s was hospitalised for dyspnoea with minimal exertion and at rest. His medical history includes hypertension, non-ischaemic cardiomyopathy, left bundle branch block and congestive heart failure (HF). He had received a cardiac resynchronisation therapy implantable cardioverter-defibrillator (CRT-D) 2 years prior to the current admission, with initial improvement in symptoms, after which he was lost for follow-up. He is currently on a medical regimen that includes a β-blocker, a loop diuretic and an angiotensin receptor blocker. Physical exam reveals elevated jugular venous pressure, crackles at both bases and a third heart sound. The chest X-ray (CXR) is …