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Abdominal bloating in a middle-aged man
  1. Lee Whitmore Eschenroeder,
  2. Eric Krieger
  1. Cardiovascular Medicine, University of Washington Medical Center, Seattle, Washington, USA
  1. Correspondence to Dr Lee Whitmore Eschenroeder, Cardiovascular Medicine, University of Washington, Seattle, WA 98195, USA; lwe{at}

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Clinical introduction

A man in his 60s with a medical history of hypertension presents to the emergency department with 5 days of progressive abdominal bloating, nausea and reduced appetite. Heart rate was 105 beats/min; blood pressure was 135/95 mm Hg; respiratory rate was 20 breaths/min; and oxygen saturation was 97% on ambient air. His physical exam result is notable for jugular venous distension, abdominal tenderness and bilateral lower extremity oedema. A 12-lead ECG was obtained (figure 1).

Figure 1

Twelve-lead electrocardiogram.


What is the next most appropriate diagnostic study?

  1. Cardiac catheterisation.

  2. Transthoracic echocardiogram.

  3. CT angiogram …

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  • Twitter @leschenroeder

  • Contributors LWE served as primary author of the manuscript. EK served as critical reviewer and advisor.

  • 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.

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

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