History of presentation
A 61-year-old male presented to hospital with dizziness and dyspnea at
rest and on exertion of 3 weeks duration. He admitted to running out of
his medications about a month prior to presentation to the emergency
department. At presentation, the patient was afebrile, New York Heart
Association (NYHA) functional class III, with an average pulse of 77,
respiratory rate 22 and blood pressure 100/82. An electrocardiograph
revealed atrial flutter at a rate of 79 with right bundle branch block.
Results of initial biochemical laboratory investigations including High
Sensitivity Troponin 1, hemogram, were normal. Significant results of
biochemical tests included NT proBNP >3000, and
subtherapeutic INR 1.2. Chest x ray showed mild pulmonary vascular
congestion.