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A woman in her 70s with rheumatoid arthritis on prednisone, hypertension and coronary artery disease presents with 2 weeks of progressive dyspnoea on exertion and orthopnoea. She is visiting the USA from Bangladesh. Her medical history is notable only for a febrile illness diagnosed as sepsis of unclear source 5 years prior. Her vital signs are normal. Physical examination reveals 2+ peripheral oedema but is otherwise unremarkable. Laboratory studies are notable for a NT-proBNP of 1456 ng/nL (reference range <101 pg/mL), undetectable troponin I and normal white blood cell count and differential. Transthoracic echocardiography, CT and MRI were obtained (figure 1, online supplemental video 1).
Which of the …
Contributors All authors were involved in patient care. DS and AP were involved in the manuscript and data collection.
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 In accordance with BMJ policy, we disclose that JM currently serves on the Heart Editorial Board. As an author of this work, he played no part in manuscript review or reviewer selection.
Provenance and peer review Not commissioned; internally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.