Clinical introduction

A 61-year-old women presented to the emergency room with acute onset dyspnoea, palpitations and severe weakness. These symptoms followed a non-strenuous physical effort a few hours before admission. She reported an unintentional 10 kg weight loss over the course of a 6-week period. Her past medical history was significant for breast cancer treated successfully with chemotherapy and mastectomy 10 years prior to presentation.

On admission, the patient was in severe clinical distress, visibly cachectic, tachycardic (heart rate 130 bpm) and hypotensive (blood pressure 80/60 mm Hg). Heart and lung auscultation revealed no abnormalities. There was pain on palpation of the epigastrium. The liver was palpable below the right costal arch. Laboratory tests revealed elevated C-reactive protein of 73.7 mg/L (normal <3 mg/L) and D-Dimers of 3648 ng/mL (normal <500 ng/mL). Serial troponins …