A patient was admitted for worsening dyspnea lasting 5 days after withdrawal of furosemide (the only medication he had used regularly so far). Chest X-ray revealed pulmonary congestion showing even character of perihilar alveolar oedema. Chest pain was not present, blood pressure 100/60 mmHg.
Laboratory results: troponin-T dynamics: 480 – 520 – 600 ng/l (0 – 2 – 6 h). ECG revealed left bundle branch block with acute repolarisation changes. Coronarography was refused by an interventional cardiologist (may be elective coronarography in future).
History of smoking, suspicion of COPD, low BMI.
Patient´s condition improved thanks to diuretic therapy (following echocardiography was performed during improvement phase). Statin, acetylsalicylic acid and a small dose of ramipril were given.
Bed-side echocardiography: