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A man in his 60s with dyspnoea
  1. Iulia-Georgiana Zehan1,2,
  2. Calina Patricia Tentea1,2,
  3. Dan Blendea1,2
  1. 1 Cardiology, Cluj-Napoca County Emergency Hospital, Cluj-Napoca, Romania
  2. 2 Department of Medicine, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
  1. Correspondence to Dr Dan Blendea, Cardiology, Cluj-Napoca County Emergency Hospital, Cluj-Napoca 400020, Romania; dblendea{at}

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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 …

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  • Contributors All authors have contributed significantly to the conception, design, writing and review of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • 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.

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