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JAMA Cardiology Clinical Challenge
March 13, 2019

New-Onset Heart Failure

Author Affiliations
  • 1Department of Cardiology, Waterland Ziekenhuis, Purmerend, the Netherlands
JAMA Cardiol. 2019;4(6):592-593. doi:10.1001/jamacardio.2019.0187

An adult with a history of alcohol abuse was admitted to the cardiac unit with progressive shortness of breath, lower extremity edema, and tachycardia, which had developed during several days. He had no history of drug use or cardiac events. On physical examination, he had warm extremities. His body temperature was 36.8°C. His blood pressure was 100/60 mm Hg, heart rate was 130 beats/min, respiratory rate was 24 breaths/min, and pulse oximetry was 98% on ambient air. There were bibasilar rales on lung auscultation. The heart sounds were normal, and bilateral ankle edema was present. Laboratory tests revealed hyponatremia (sodium, 124 mEq/L [to convert to millimoles per liter, multiply by 1]), a compensated metabolic acidosis with a bicarbonate concentration of 14 mEq/L (to convert to millimoles per liter, multiply by 1), and a lactate concentration of 82.0 mg/dL (to convert to millimoles per liter, multiply by 0.111). The D-dimer level was 0.0003 μg/mL (to convert to nanomoles per liter, multiply by 5.476), and the pro–brain-type natriuretic peptide level was 6062 pg/mL (to convert to nanograms per liter, multiply by 1). The electrocardiogram on presentation is shown in the Figure. Echocardiography (Video 1 and Video 2) revealed a left ventricular ejection fraction of 50%.

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