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An elderly man with acute-onset breathlessness
  1. Chinmay Parale,
  2. Ramanathan Velayutham,
  3. Sridhar Balaguru
  1. Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
  1. Correspondence to Dr Chinmay Parale, Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India; chinmayparale{at}gmail.com

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Clinical introduction

A man in his 70s with diabetes and hypertension presented to us with a 6-hour history of acute rest angina. His pulse rate was 110 beats/min and his blood pressure was 124/80 mm Hg. Systemic examination was unremarkable. ECG showed sinus tachycardia and T inversions in the lateral precordial and limb leads. Echocardiography was notable for a hypokinetic lateral wall and mildly reduced left ventricular systolic function. Troponin levels were highly elevated, and the patient was hospitalised with a diagnosis of non-ST elevation myocardial infarction. One day after admission, the patient developed acute-onset breathlessness at rest with orthopnoea. On clinical examination, he had a soft systolic murmur …

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Footnotes

  • Twitter @chinmayparale, @DrRamanathanV

  • Contributors CP conceptualised and drafted the manuscript, was involved in patient management and was responsible for the overall content of the article. RV contributed towards the literature review and was involved in patient management. SB edited the manuscript and was involved in patient management.

  • 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.

  • 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.